To address the burden of COPD on hospital expenditures, on October 1, 2014, the Centers for Medicare & Medicaid Services included COPD in its Hospital Readmissions Reductions Program. This inclusion resulted in reduced Medicare reimbursement for hospitals that demonstrate excessive 30-day COPD patient readmission rates.
Chronic obstructive pulmonary disease (COPD) includes persistent pulmonary inflammation resulting in parenchymal tissue destruction and disrupted repair and defense mechanisms, and leads to air flow limitation, air trapping, and breathlessness.1 Approximately 15 million adults in the United States report that they have been diagnosed; however, the actual number of adults with COPD is believed to be much higher because an estimated 12 million adults remain undiagnosed with the disease.2,3 As the third leading cause of death in the country, COPD represents a significant burden.4 In 2010, it resulted in $29.5 billion in direct healthcare expenditures.5 In 2008, there were more than 820,000 hospitalizations for COPD among adults aged 40 years and older.6
Dr AminTo address this burden, on October 1, 2014, the Centers for Medicare & Medicaid Services included COPD in its Hospital Readmissions Reductions Program. This inclusion resulted in reduced Medicare reimbursement for hospitals that demonstrate excessive 30-day COPD patient readmission rates.
Implementation of a multidisciplinary approach to patient care and focused attention on transitions of care from admission through discharge and outpatient follow-up is essential for successful management of care. Pharmacists hold a unique position in the patient care continuum. They serve a number of roles including being a patient point of contact, a care coordinator with physicians, and an interface with the formulary manager. Moreover, pharmacists hold important roles in patient follow-up and adherence to medication. Appropriate treatment algorithms, medication, and training are all within the purview of pharmacists and can improve COPD readmissions.
Formulary managers have the essential responsibility to make treatment options available for physicians to prescribe to their diverse patients with unique disease statuses and comorbidities. Furthermore, their attention must also include the course of integrated, chronic care to enable adequate transition from inpatient care to outpatient care. The challenge that the formulary manager faces is to provide a broad inventory of medication that meet diverse patient needs in a cost-efficient manner. Attempts to balance these priorities can lead to formulary restrictions that may prevent the ability to offer and prescribe the best medication affording the best transitions of care.
The role of the formulary manager can include the ability to help determine, along with physicians and pharmacists, in-patient treatment algorithms that conscientiously include solutions for patient diversity, optimal medications based on efficacy and safety in certain situations, and the transition of care. Of course, continuous evaluation of cost effectiveness of medications in the specific environment in which the formulary manager serves remains of importance.7 Additionally, contracting for best price and using the savings to expand formulary offerings that more completely cover the breadth of necessary medications for diverse populations and situations remains the responsibility of the formulary manager.
At the center of all formulary activities is the unique and significant interaction between formulary managers and pharmacists that helps facilitate the goals of the prescribing physicians through negotiation of interests between all groups. Thus, open communications between pharmacists and formulary managers aids a successful outcome for patients with COPD by encouraging optimal treatment availability and medication adherence.
Dr Amin is a member of the multidisciplinary steering committee guiding the COPD Foundation 2nd Readmissions Summit. He is chair of the department of medicine, a professor of medicine, and executive director of the Hospitalist Program, School of Medicine, University of California, Irvine.
1. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–365.
2. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease among adults-United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61(46):938–943.
3. National Heart, Lung, and Blood Institute. What is COPD? http://www.nhlbi.nih.gov/health/educational/copd/what-is-copd/index.htm. Accessed March 17, 2015.
4. Hoyert DL, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012;61(6):1–65.
5. Schulman, Ronca and Bucuvalas, Inc. (SRBI) Confronting COPD in America, 2000. Funded by Glaxo Smith Kline.
6. Agency for Healthcare Research and Quality. Center for Delivery, Organization, and Markets. Healthcare Cost and Utilization Project. Nationwide Inpatient Sample (NIS), 2008.
7. Levine M, Taylor R, Ryan M, Sculpher M. Decision-making by healthcare payers. Respir Med. 2002;96(suppl C):S31–S38.