Gain Referrals by Reducing Readmissions
by Robert Kent

Effective this year, Section 3025 of the Affordable Care Act penalizes hospitals for COPD readmissions. During the next three years, hospitals will be charged a 3 percent penalty on all Medicare reimbursements for patients readmitted within 30 days of discharge.

The reality of an industry average 25 percent readmission rate creates a captive audience for real discussions on better therapy. These meaningful conversations can save hospitals massive amounts of money and generate more patient referrals. Set yourself apart with results-driven programs that can protect hospitals from these new financial risks.


Comprehensive patient training programs are the first line of defense against readmissions. It is important to educate patients about symptoms they may experience. A patient's inability to catch his or her breath due to overexertion and panic will be the most likely cause of a readmission. Patients need to know they can manage their breathing alone most of the time. Stopping, remaining calm and taking a moment to catch their breath must be well-emphasized and rehearsed with care providers.

Size Matters

An ounce of prevention is worth a pound of cure, and too little oxygen often increases the risk and rate of readmissions. A retail focus on portable oxygen concentrators (POC) has left patients fixated on weight and battery life with little interest in therapeutic results. On the other hand, providers and hospitals do not have the luxury of going small and risking readmission. The most important size to focus on is the amount of oxygen being delivered.

In the POC arena, a pulse-mode setting of 2 was once considered the standard equivalent for 2 liters per minute (LPM) on a continuous flow device. This is no longer the case. Different theories on pulse wave, duration, etc. have resulted in a wide range of interpretation. Larger dual-mode POCs capable of 3 LPM will deliver 16 mL per setting, yielding 32 mL of pulse bolus at a setting of 2. Smaller machines reduce the bolus to 12 mL or 8 mL per setting to achieve longer battery life with smaller pumps. In some cases you can be getting 50 percent less oxygen on a setting of 2, and higher breathing rates can cut that down further.

In the early stage of patient care, more oxygen is better. The best option is a dual mode POC or oxygen-conserving device that can offer both continuous and on-demand oxygen. Pulse mode will allow patients longer ambulation with plenty of bolus size to support higher breathing rates. They also have the security of continuous flow if needed. With good patient education and doctor cooperation, you can work them into smaller equipment over time and safely manage them into the products they desire.

Get Patients Moving

A good plan should ensure patients are ambulating and receiving adequate oxygen to support them while out and about. Lightweight is typically the main focus, while adequate oxygen supply and continuity are often overlooked.

Although heavier in weight, a dual-mode POC as a 24/7 device can lead to better ambulation through familiarity. Most can be easily wheeled around on carts and will provide patients with plenty of oxygen. When used initially as a 24/7 device, the patient develops a great deal of confidence as it accelerates familiarity with their ambulatory solution. Unplugging and wheeling out their everyday machines can be a lot less daunting than refamiliarizing themselves on another ambulatory device or home-filling a small tank.

Using a dual mode POC as a 24/7 device also carries a billing advantage because you can bill codes E1390 and E1392 on one machine. Once a patient gets comfortable ambulating, and you verify they can stay saturated on a pulse bolus of 16mL to 32mL, you can outfit them with any number of smaller machines paired with an in-home stationary device. Again, doctor cooperation and patient education is key.

Monitor Your Patients

Ensuring results is a compelling point in gaining referrals. As a provider, you should become familiar with remote monitoring technology. Almost every aspect of patient care is going wireless, and it will be more and more prevalent and cost effective during the coming years. As with all advancements, early adopters usually reap the biggest benefits. Make the effort to learn what solutions are available and whether they can help you secure more referrals and ensure better outcomes for your patients.