Lungs and Breathing

Riverside Tappahannock Hospital Lowers Readmission Rates For COPD Patients

April 15, 2015

A campaign at Riverside Tappahannock Hospital to lower readmissions for sufferers of Chronic Obstructive Pulmonary Disease (COPD) has not only been proven hugely effective, it has also garnered state and national recognition.

COPD 30-day readmission rates dropped about 15 percent over a two-year period, according to Riverside Tappahannock Hospital statistics. The rate in 2014 was 6.7 percent, down from 21.6 percent in 2012.

Sufferers of COPD are typically above 65 years of age and on Medicare. It's the third-leading cause of death in the U.S., according to the Centers for Disease Control. COPD refers to a group of diseases that cause airflow blockage and breathing-related problems and includes emphysema, chronic bronchitis and in some cases asthma.

Mike Pierce, a respiratory therapist at Riverside Tappahannock Hospital, helped spearhead the effort to reduce readmissions for COPD. The impetus was a change in Medicare payments to hospitals with high readmissions for patients with COPD.

Under the federal Affordable Care Act, hospitals such as Riverside Tappahannock would be penalized for excessive readmissions — patients readmitted within 30 days — for COPD.

"We knew several years ago that Medicare was going to come out with COPD readmission penalties," Pierce said. "We knew we had to get ready for it and we came up with a very productive process to do so."

Riverside Health System organized the COPD efforts into what is called a "Patient Care Coordination Council." Representatives from across the continuum of care meet biweekly to discuss ways to improve the care of COPD patients within the Riverside system.

Pierce co-leads the effort along with Kathy Koehl, from Riverside Regional Medical Center in Newport News, and the physician champion, Dr. James McDaniel, of Riverside Shore Memorial Hospital in Nassawadox.

Pierce said the group developed branded material exclusive to Riverside Health System that took a couple of years of planning, alterations and small changes to come up with a workable product.

A booklet was developed specifically for COPD that covers a whole range of topics, Pierce said. When patients are admitted, they are taken through the booklet and asked key questions to demonstrate an understanding of the content, he said.

An action program is developed so the patients know how to manage the disease when they go home and when to call 911 — or not to call.

"We spend a lot of time talking about that," Pierce said.

COPD carries a significant health care financial strain, with $35 billion in direct and indirect costs nationally. "That's a huge health care burden," Pierce said. "Anything we can do to reduce that burden obviously saves us all in health care costs."

In economies of scale at a small hospital like Riverside Tappahannock, even small reductions in readmissions can make a big difference, Pierce said.

In January, Pierce presented to the Virginia Hospital and Healthcare Association on the results of Riverside Tappahannock Hospital's COPD campaign. It was part of a patient safety summit in which members submit an abstract for a poster to be presented that represents improvements in patient safety or quality of care, or more effective processes that improve outcomes.

"These presentations allow members to share ideas and processes with other members to improve the overall quality and safety of patient care in Virginia," Pierce said.

"This is a respiratory therapist-driven process," Pierce said. "This is one of the first programs in Riverside Health System in which the therapists are out there doing the bulk of the heavy lifting. We're doing a lot of assessment and patient education."

The COPD campaign has proven rewarding for Pierce. Patient response has been favorable and it's "good to make a positive contribution to patient care and actually be recognized for it," he said. "I've been a respiratory therapist for 38 years. This is probably the most exciting and rewarding part of my career I've had. What you're doing is making a difference. We've done some things to really make a difference in people's lives."

Treating COPD is a huge topic among health care providers across the country, Pierce said. "I think we've got one of the more successful models in the country," he said.

In June, Pierce will be presenting the COPD campaign at a national conference in Scottsdale, Ariz., put on by a medical software provider.

"They extended an invitation in June to speak to a group of clients," Pierce said. "It's an opportunity to go out and talk about what we're doing at our little hospital in Tappahannock."