Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions: A Negative Study That Has Positive Implications

A report by Bhatt and colleagues (pp. 643-648) published in this issue of AnnalsATS (2) describes a single-center pre-post intervention study that examined the efficacy of a Medicare Bundled Payments For Care Improvement (BPCI) initiative (3) in reducing 30-day readmissions and in- and outpatient costs for up to 90 days after discharge of patients hospitalized and coded with one of three COPD diagnosisrelated group (DRG) codes (190-192). The population studied was small: just 78 patients in the intervention group and 109 in the control group. [...]although no power calculations were reported by the group, the study was likely underpowered to show a significant difference in time to first readmission. [...]the authors did not adjust the hazard ratio for comorbidities known to be associated with COPD readmission rate that, although not significantly different between the two groups individually, may have made a difference when used in aggregate to adjust the hazard ratio (4, 5). Most published studies do not examine the 30-day readmission rate, underscoring the possibility that the CMS endpoint is arbitrary (6). [...]almost all published studies are retrospective in design and reliant on International Classification of Diseases or DRG coding applied late in the admission or after discharge to identify patients. Another limitation of this study is that it excluded patients with two diagnoses included in the CMS HRRP: (1) end-stage renal disease, and (2) acute respiratory failure as a primary diagnosis, with COPD as a secondary diagnosis. Chronic kidney disease, including end-stage renal disease, is a common COPD-related...