Analysis finds that non-invasive ventilation treatment reduces hospital admissions and lowers costs
Change in the healthcare industry moves slowly, sometimes too slowly from the patient’s perspective. Patients with chronic obstructive pulmonary disease (COPD), for example, have historically been prescribed the same home treatment for their condition for decades: a bilevel positive airway pressure (BPAP) device.
While superficially helpful in some instances, a BPAP device tends to exacerbate other symptoms, which can lead to additional emergency department (ED) visits, admissions, and a worsened patient experience. However, a more effective home treatment for COPD is increasingly recommended by case managers and hospitalists across the country. Newer, non-invasive ventilation (NIV) devices are available that automatically sense and deliver air to patients only when needed, instead of the non-stop, high-and-low pressures of the BPAP. As such, the patients’ respiratory rate stabilizes faster, which likely reduces the anxiety associated with an exacerbation.
NIV treatment also leads to fewer admissions, lower costs and likely contributes to an overall better patient experience, especially for COPD patients with chronic respiratory failure (CRF), according to a recent study by KPMG, an independent global accounting and advisory firm with a leading healthcare data analytics practice. Reviewing four years of claims data, KPMG found that COPD patients with CRF using the newer NIV devices combined with a high-touch home care model, which included set up and support from a certified respiratory therapist, saved the Centers for Medicare & Medicaid Services (CMS) more than $14,000 per patient per year compared to BPAP. NIV patients receiving a high-touch home care model also had an admission rate of less than 20 percent after six months of treatment, while 26 percent of patients treated with BPAP therapy were admitted.
The study findings offer compelling evidence that NIV therapy, particularly in conjunction with high-touch home care and education by a certified respiratory therapist, offers true value-based care that encompasses lower costs along with a better patient experience and quality of life.
Home BPAP stuck in the past
Physicians have been prescribing home BPAP devices for their COPD patients with CRF for many reasons. BPAP has a long-established history of home use, and likewise, more literature is available. In addition, when a COPD patient arrives in an ED, they are often placed on a hospital-grade BPAP, which is more advanced and configurable than the home devices. For example, a hospital BPAP can be set to deliver a specific tidal volume, while the home devices typically cannot.
And, not taking into consideration outcomes-related costs, the older home technology has lower immediate costs than the newer NIV devices, which entered the market around 2012. Costs of BPAP therapy, however, are higher over the long-term compared with NIV therapy, when factoring in more frequent hospitalizations and/or longer stays.
Patients with end-stage COPD who are treated with BPAP therapy are hospitalized more often most likely because the device does not adequately treat their symptoms. BPAP was created to treat sleep apnea and alternates between high-and-low air pressure during inhalation and exhalation. COPD patients with CRF, however, need to fully exhale to eliminate the excess carbon dioxide in their lungs. The newer NIV devices pause positive pressure to allow for that full exhalation before assisting the patient with the specific, customized air pressure they require. This enables patients to slow their respiratory rate and likely eases their anxiety.
Moreover, COPD exacerbations tend to occur more often during the day. The newer NIV devices feature day and night modes, which deliver the different pressures required during waking and sleeping hours. The most commonly prescribed home BPAP devices, however, do not offer that flexibility.
High-touch care model essential
The newer NIV devices seem to keep COPD with CRF patients out of the hospital more often than BPAP, according to the KPMG study, but the personal care COPD patients receive appears to play an integral role as well. Among the cohorts studied in the KPMG analysis, one group that was prescribed the newer NIV devices received a high-touch home care model from a leading home healthcare supplier. The care model includes set up and multiple home visits by a certified respiratory therapist to ensure the NIV therapy is being used correctly and to its maximum potential.
Importantly, certified respiratory therapists are also on call if patients or their caregivers have questions or concerns. In COPD exacerbations, patients are often distressed because they cannot breathe; they may call an ambulance that takes them to the ED, and none of this eases their anxiety. With an on-call respiratory therapist, patients have calming and highly-trained healthcare professionals to guide them through the exacerbation using the NIV, reducing their anxiety and likely preventing unnecessary 911 calls.
Not surprisingly, the group receiving the high-touch care model recorded the lowest monthly and accumulated post-treatment costs of all populations, according to the KPMG study findings. Total annual costs for BPAP patients studied were $69,495, while total costs for the high-touch home care model NIV patients were $55,375. Moreover, inpatient spending for BPAP patients increased 32 percent in that year, while all NIV patients had a 6 percent decrease in inpatient spending. While a clear correlation exists, KPMG did not specifically study if the enhanced service feature directly contributed to reduced admissions.
Lower costs, improved experiences
COPD is the third-leading cause of death in the United States, affecting as many as 24 million Americans. COPD is also a slowly progressive chronic condition responsible for more than $20 billion in indirect economic costs and $30 billion in healthcare expenditures each year.
Trends like these are part of the reason value-based payment is increasingly impacting more healthcare organizations. Government and commercial payers are placing greater scrutiny on the quality of care delivered and the meaningful value of the services they are reimbursing. A transition from the short-term savings of prescribing BPAP for COPD patients with CRF to the longer-term overall cost savings with NIV therapy is not only better for patients — it also makes good business sense.
Similarly, patient experience and engagement are also more closely examined with value-based care payment. Few, if any patients, want to spend more time in the hospital. They want to be home with their loved ones and feeling empowered by managing their chronic condition on their own. Newer NIV devices coupled with a high-touch home care model can help those patients safely and effectively achieve those goals while also improving quality and cost metrics for the healthcare organization.
About the author:
Casey Hoyt is chief executive officer of VieMed, a leading provider of post-acute home respiratory services.