Hospital at Home for COPD Patients

In the United States, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death. Almost 15.7 million Americans live with COPD and other respiratory diseases that cost the health care system over $50 billion each year. The number of people living with COPD is expected to double to 31 million by 2050.

Marked by a chronic cough, lung inflammation and buildup of thick phlegm in the lungs, COPD permanently damages lung capacity and function. Reduced oxygen levels cause the patient to experience shortness of breath, wheezing and fatigue, making it challenging to perform even the most basic physical activities.

Caretakers and families of people living with COPD witness firsthand how devastating the disease can be on a person’s quality of life. The result is often a downward spiral toward an increasingly sedentary lifestyle, leading to more frequent and serious respiratory infections and exacerbations requiring emergency room visits and hospital admissions.

Although there is no known cure for COPD, effective treatments combined with 24/7 monitoring can delay disease progression and improve quality of life and life expectancy. Telehealth and digital home health monitoring are proving vital to safely manage patients in virtual care models. The right remote monitoring technologies can reduce adverse events, the risk of mortality and hospital readmission rates while also lowering overall direct care costs.

Better Care Management

Meeting the needs of patients with COPD is a high priority for health systems across the U.S. About 800,000 patients are hospitalized for COPD annually, making it among the leading reasons for hospital admissions—with about 20% discharged and readmitted within 30 days.

Frequent readmissions are not only distressing to patients, but also costly to health systems. Financial penalties can be applied for excessive 30-day readmissions. Therefore, incentivizing health systems to improve communication and care coordination that better engages patients and caregivers and informs discharge plans may, in turn, reduce avoidable readmissions.

Early diagnosis, treatment and disease management are critical elements for reducing hospital admission and readmission rates, and to improving the quality of life for millions of people with COPD. The disease can be managed with medications, oxygen therapy and pulmonary rehabilitation to slow progression, in addition to smoking cessation support and education about healthy lifestyle changes. Patients must strictly follow their medication schedules, including the appropriate use of inhaler treatments and rescue inhalers when necessary. They may also be prescribed daily oral steroids or antibiotics to prevent and treat infections. Patients with chronic disease may hesitate to report worsening symptoms in a timely fashion because they don’t want to burden their loved ones and caretakers. Hospitals, clinicians and home health professionals need better strategies to safely monitor and treat patients living at home with COPD.

Keeping chronic care patients from deteriorating or developing complications is a significant driver for reducing unnecessary hospital utilization, especially in a
value-based care model. As health systems adopt virtual care models to enhance care and optimize workflow, they also need to ensure that the investment provides a positive return.

Hospital at Home & RPM

In 2020, the Centers for Medicare & Medicaid Services (CMS) introduced the Acute Care Hospital at Home (ACHaH) program, which provided a waiver enabling the use of virtual care models to manage acute patients at home and benefit from the equivalent inpatient fee-for-service payment. Although still in its infancy, the ACHaH reimbursement model makes home health care more economically viable for patients with acute exacerbations of COPD and other acute conditions.

CMS has also introduced innovative programs to help clinicians manage chronic disease patients to prevent deterioration and identify early intervention opportunities to avoid rehospitalizations and drive down costs. The reimbursement of remote patient monitoring (RPM) targets health management by allowing clinicians to claim reimbursement for monitoring at-home patients—specifically, to measure vital signs and submit to the clinician and to initiate regular appointments to discuss and assess their health. As CMS promotes these payment incentives to support the value of the home-based consumer experience, many other managed care organizations, self-insured employers and private payers are following suit.

The concept of transitioning patients to the home has existed for decades, and many studies have demonstrated the clinical and economic benefits. In this evolving environment, it is estimated that ultimately, 20% more clinical services annually will move to the home—which calls for a technology ecosystem that is ready to support the transition.

A broad, continuous remote patient monitoring (cRPM) approach consolidates surveillance by detecting any kind of physiological abnormality and providing exception-based notifications of where a clinician should focus their attention. A flexible and configurable enterprise platform spans the continuum of care from low acuity to high acuity in-home patients. Near real-time continuous vital sign monitoring with Food and Drug Administration-cleared and validated artificial intelligence (AI) algorithms identifies patient deterioration, triggering early intervention and helping avoid unnecessary health care utilization.

AI-driven cRPM does not replace an expert clinician when it comes to diagnosing patients or dictating medical interventions. Rather, it separates the data from the noise by providing clinicians access to accurate and objectively measured changes in physiological behavior that provide insight into the patient’s medical story. This allows the clinician to direct their investigation to the right patients at the right time and make the most informed treatment decisions.

The more data collected, the better a clinical care team can understand how an individual with COPD exacerbates, what triggers the exacerbation, and what works and doesn’t work in terms of treatment. The predictive analytic algorithms can detect personalized physiologic patterns and anomalies so subtle that even the patient may not yet have noticed something is wrong. Armed with objective clinical insights, a respiratory therapist at a hospital or outpatient clinic can quickly adjust the patient’s treatment plan to prevent an exacerbation before escalating into a serious episode that requires an emergency room visit or hospitalization.

Patient care, satisfaction and trust matter most—especially for those who require extended and varied levels of care. Some have questioned whether people will fully embrace remote care models. In 2020, as the global pandemic and health care needs surged, health systems pivoted from traditional care models to those that supported remote patient interaction. Telehealth and remote patient monitoring tools were quickly deployed. Adoption and acceptance were remarkably high among clinicians, patients and payers as they realized the inherent convenience, ease of use and affordability digital health offers without sacrificing the quality of care.

Moving forward, health systems are expected to leverage successful virtual care models and ACHaH programs to create positive patient monitoring experiences, reduce overall costs and improve clinical outcomes for the growing number of people living with COPD and other chronic respiratory diseases.