Impact of a COPD Bundled Payments for Care Innovation Program on Readmissions and Inpatient Care Quality: an Instrumental Variable Analysis.

Background: One-fifth of US patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are readmitted within 30 days, contributing to high morbidity and costs. Medicare included COPD in their Hospital Readmissions Reduction Program (HRRP) in 2014 and offered voluntary value-based COPD care programs (Bundled Payments for Care Innovation [BPCI]). Research Question: Was our COPD Hospital Readmission Reduction Program (COPD HRRP) effective in preventing hospital readmissions and improving inpatient care quality at our medical center? Study Design and Methods: We performed a single-center, retrospective cohort study using Medicare data of BPCI-eligible hospitalizations for AECOPD occurring pre-BPCI (October 2013 - September 2014) and during BPCI (October 2015 - September 2018) implementation. Our inter-professional COPD HRRP includes inpatient consultation and post-discharge interventions. We compared outcomes between BPCI program recipients and non-recipients including inpatient COPD care quality metrics derived from international COPD guidelines and program-specific interventions using multivariable regressions. We evaluated 30-day and 90-day all-cause readmission rates with multivariable logistic regression and two-stage least squares instrumental variable analysis (IVA). Results: Of 287 AECOPD hospitalizations (pre-BPCI: n=57; BPCI: n=230), 132 received the COPD HRRP. Patients were more likely to receive inhaler education (pre-BPCI: 12.0% vs. BPCI: 71.8%; Interpretation: The implementation of an evidence-based BPCI COPD program was associated with significant decrease in 30-day all-cause readmissions. Future studies are needed to assess individual interventions that may impact readmission reduction.