In all of the COPD-related news lately, there is a little bit of good news. Even after COPD was added to the list of monitored conditions, 799 U.S. hospitals will not be assessed readmission penalties in 2016.1 The bad news is, this accounts for less than 24% of those hospitals participating in the readmission reduction program. CMS has assessed the other 75+% with readmission penalties for the coming year. And 38 hospitals will incur the maximum 3% reduction, according to a Modern Healthcare analysis of newly posted CMS data.2
This levy is taking an even greater toll on rural hospitals. According to the University of Minnesota Rural Health Research Center, “Lower-volume rural hospitals (those with less than 100 beds, 7,000 adjusted annual admissions, or 2,200 Medicare discharges) were more likely to receive readmission penalties than small urban hospitals …” Their study showed that both “rural and urban hospitals located in counties with fewer resources and greater needs are more likely to incur readmission penalties, adding to previous research showing that readmission penalties disproportionately affect safety-net hospitals and those located in lower income communities” and emphasizes that while “the dollar amount of readmission reduction penalties may not seem large for the average rural hospital, the overall financial condition of many rural hospitals is precarious: the average Medicare acute inpatient margin for a rural PPS hospital was -2.6% in 2012, and several rural hospitals have closed since 2010.” That would be 58 rural hospitals to date, with the most recent closing just last month.4 As Angela Mattie, chairwoman of the Health Care Management & Organizational Leadership department at Connecticut’s Quinnipiac University observes, “The stand-alone, community hospital is going the way of the dinosaur.”5
This leads to insight number three: Not only is COPD most prevalent among America’s rural poor and is most deadly in that population, but their disease condition is indirectly and inadvertently limiting their access to care. It is the catch-22 of COPD in rural America.