Editorial on CMS Quality Measures

August 12th, 2011 | Author: Katelyn Turner

This blog post was written by Jane Martin, BA, LRT, CRT

Historically, people with COPD (diagnosed or not) have been caught in a cycle of having repeated “flare-ups” or “episodes” of their breathing problems, in medical terms, “acute exacerbations of COPD (AECOPD).”  When these episodes have occurred, patients seek help from the local emergency room and possibly be admitted to the hospital overnight or for a number of days. Respiratory therapists, nurses and doctors do their part in helping patients breathe better and get through an exacerbation.  Once breathing has improved, patients are discharged and sent on their way, often back to the same low level of care, expertise and support that they had previous to the episode. Sound familiar? Surely then, it’s no surprise that the same patients return to the ER (many times within 30 days) and or the acute care ward only to repeat the same course all over again.

Thus, patients are passing again through the door – that tired, old revolving door – leading not to better lung health management but to a downward spiral in health. Through it all, people (and their loved ones) are living not a life of confidence and control – at the very least, management – of the disease, but simply leading an existence fraught with uncertainty and confusion – living at the mercy and the whim of a terrible disease.

That’s how it has been and that’s how it is. But it shouldn’t be, and come October of 2012, it will no longer be acceptable to “manage” COPD in this way.

The COPD Foundation commends the Centers for Medicaid and Medicare Services (CMS) efforts to board up that revolving door once and for all by developing strong hospital-level quality measurements that will begin to uncover the seriousness of the issues facing hospitalized individuals with COPD.  The use of these measures will ensure that hospitals nationwide place a priority on improving COPD care.

The COPD Foundation believes that in addition to putting into place best care practices for hospitalized individuals with COPD (medications, oxygen, infection control, etc.), treatment and care should include comprehensive patient education and means of ongoing support to put to use what’s been learned.  We know patient education works not only in reducing hospital admission rates in people with diabetes, but in empowering them to control the effects of their disease, thus improving the quality of life. Why should it be any different for the 12-24 million Americans with COPD, the now number three cause of death?

The COPD Foundation sees an immense potential for better COPD care if this is done right. A few of these practices would involve Respiratory Therapists to be included as part of the health care team in both the transitional care setting and in the home, providing care and education specific to their needs. Research indicates that RT’s at home keep people out of the hospital and lead to an improvement in their understanding of their disease.


  1. Great post! There’s such a huge opportunity for hospitals and home care providers to collaborate on the proactive coordination of care for COPD patients. The beauty of home care is that it serves to educate patients and their caregivers on ways to manage conditions like COPD in the home setting. Little things make huge impacts – like reorganizing your activities of daily living (i.e. bathing, cooking, cleaning, etc.) so that you minimize shortness of breath and conserve energy. Giving COPD patients access to info/resources to maintain their health proactively prevents ER visits, hospital readmissions and unnecessary claims costs while enabling an improved quality of life. We’ve got to start thinking outside our current health care paradigm if we’re going to improve things! Thank you for posting this piece!

  2. Susan Cline says:

    Just got out of hospital for 3rd time this year. No more. I can do steroids and antibiotic at home. My insurance will no longer cover a visit to ER unless I am admitted to hospital. How would I know if my flare up is severe enough to be admitted ? I can no longer hold 90% and I’m on 4 liters of O2 so all I do is sleep and I can do that at home too. They don’t really do anything for me anymore except cost!!! I find COPD sites good if your not in the last stages.

  3. Robbin says:

    It would be good if there was an affordable insurance or free insurnace for those on ssi and or ssdi or clinics to cover all the expenses for the disease. Maybe that would help them not go to ER and end up staying in the hospital.
    It maybe the only way they can get meds to help. I have COPD and finding that it’s taking alot of research and networking to just get the information.

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