Sustainability Strategies for COPD
There are several strategies rural COPD programs are using to sustain programs that may be useful for rural
healthcare systems and providers. The Rural Community Health Toolkit provides information about general Sustainability Strategies and Sustainability Strategies for Specific
Reimbursement for COPD Services
Several rural COPD programs rely on reimbursements from Medicare, Medicaid, and private insurers to finance COPD
The Centers for Medicare and Medicaid Services (CMS) plays a prime role as a major payer of COPD-related
services for patients enrolled in Medicare and Medicaid. For example, Medicare Part B covers
several COPD-related services such as pulmonary rehabilitation,
smoking cessation, and oxygen therapy or oxygen equipment and accessories.
Some states have begun to pass legislation that expands the definition of "healthcare providers." For example,
in January 2019, Ohio passed Senate Bill 265
allowing for the designation of pharmacists as healthcare providers. Pharmacist services that may now be covered
include drug therapy management and vaccine
administration. This designation will allow pharmacists
new billing options in order to expand access to care for many patients.
Other Payment and Reimbursement Considerations
One of the most common goals of COPD programs is to reduce hospital readmission rates. In 2015, Medicare added
COPD as a condition for the Hospital
Readmissions Reduction Program, a value-based purchasing program that measures hospital performance
using excess readmissions within a 30-day period. Many programs indicated that being able to demonstrate that
their COPD-related efforts had reduced hospital readmissions created buy-in from the administration and senior
staff. Additionally, the Merit-Based Incentive Payment System
(MIPS) also includes COPD-related quality measures.
Of note, the National Advisory Committee on Rural Health and Human Services' Addressing
the Burden of Chronic Obstructive Pulmonary Disease (COPD) in Rural America included three policy
recommendations, two of which were related to payment rates and reimbursement:
“The Committee recommends the Secretary and the Department of Health and Human Services
undertake a national campaign to educate rural primary care providers and individuals with COPD
symptoms about rural-urban disparities in COPD outcomes with an emphasis on the need to do more
screening and referral for effective treatments to help manage the disease.
The Committee recommends that prior to the next revaluation of outpatient prospective payment
rates, the Department of Health and Human Services consult with experts in pulmonary treatment to
refine the definition of rehabilitation services and, in Medicare cost reports, confirm that there is
adequate accurate data on this service to be used as a basis for the rate.
The Committee recommends the Secretary work with Congress to expand direct supervision of
pulmonary rehabilitation to include physician assistants, nurse practitioners and other primary care
providers under general supervision of a physician.”
Resources to Learn More
Patients with COPD at High Risk of Readmission
Discusses hospital readmission rates within 30 days of discharge for COPD patients and determines risk of
readmission by tracking a variety of demographic data, including age, comorbidity status, and payer type.
Author(s): Simmering, J., Polgreen, L., Comellas, A., Cavanaugh, J., & Polgreen, P.
Citation: Chronic Obstructive Pulmonary Diseases, 3(4), 729-738