Patients aren’t the only ones who benefit from chronic obstructive pulmonary disease (COPD) treatment. Positive COPD outcomes also help physicians drive more money to their bottom line. That’s because by helping patients manage their COPD symptoms—and, ideally, prevent hospitalizations—physicians may receive a bonus for controlling costs.
COPD is one of many conditions targeted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal law that seeks to improve outcomes and lower costs among patients covered by Medicare.
Beginning in 2020, physicians participating in the Merit-based Incentive Payment System (MIPS), one of two participation tracks under MACRA, will be penalized for costs that exceed anticipated amounts, or rewarded for keeping costs under the projected amounts. The Centers for Medicare & Medicaid Services (CMS) will use 2018 claims data to determine the payment adjustments.
“I think where physicians have the biggest ‘bang for their buck’ in terms of keeping patients healthy is through education and helping them understand how their life choices will affect their chronic conditions,” says Raemarie Jimenez, CPC, vice president of membership and certification at AAPC, an organization representing medical coders, billers and compliance managers.
When patients understand how to use their rescue inhaler properly, for example, they may be less likely to go to the emergency department and thereby drive up costs unnecessarily, she adds.
The time to act is now, Jimenez adds. Physicians shouldn’t delay addressing reasons why patients with COPD are admitted and readmitted to the hospital. “Even though the penalty isn’t going to hit you until , if you don’t do the work now, you can’t go back in time and fix it,” she adds.
Patient education affects these four COPD-related quality measures under MIPS:
- COPD: Prescribing long-acting inhaled bronchodilator therapy
- COPD: Performing spirometry evaluation
- Preventive care and screening: Tobacco use—screening and cessation intervention
- Tobacco use and help with quitting among adolescents
Primary care physicians play an important role in cost-reduction measures because they’re the ones who likely see patients most frequently and can provide critical education about COPD triggers and how to use inhalers, says Rex Mahnensmith, MD, a solo internist in Hartford, Connecticut. Approximately 35% of Mahnensmith’s patients have COPD, and another 30% have asthma.
Use empathy, withhold judgment
Experts agree that cost containment starts with understanding each patient’s unique challenges. This allows physicians to identify the best course of treatment for patients with COPD, many of whom downplay their symptoms and ultimately end up hospitalized when there is no intervention.
There’s also a stigma associated with COPD, according to Regina Lohr, MPP, senior consultant at Advisory Board, a healthcare consulting company in Washington, D.C. “Patients may feel like they have brought it on themselves through smoking, so they may be embarrassed to seek care,” she says.