SHM Converge Scientific Abstract ePoster Gallery-Association of Out-of-Pocket Costs After Chronic Obstructive Pulmonary Disease Hospitalization With Six-Month Readmission: An Instrumental Variable Analysis

Association of Out-of-Pocket Costs After Chronic Obstructive Pulmonary Disease Hospitalization With Six-Month Readmission: An Instrumental Variable Analysis

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This study examined whether higher out-of-pocket costs (OOPCs) from a COPD hospitalization are associated with higher six-month readmission risk. Using MarketScan commercial claims data from 2016–2021, the authors studied adults hospitalized for COPD in months when patient costs are affected by the January deductible reset. They used an instrumental variable design, treating January-related variation in OOPCs as quasi-random among patients who were likely to meet their deductible.<br /><br />The main outcomes were six-month readmissions for any cause, for COPD, and for motor vehicle crash/trauma. The analysis included several patient and hospitalization characteristics, such as age, sex, insurance type, comorbidity burden, length of stay, ICU use, and discharge disposition.<br /><br />Results showed that higher index-hospitalization OOPCs were associated with increased readmission risk among marginal patients. Specifically, a $1,000 increase in OOPCs was linked to 13.5 additional all-cause readmissions per 1,000 patients and 12.7 additional COPD readmissions per 1,000 patients. There was no meaningful association with MVC/trauma readmissions.<br /><br />The findings suggest that acute financial burden after hospitalization may worsen outcomes by reducing medication adherence, delaying follow-up care, or limiting access to supportive resources such as transportation, food, and home assistance. The effect appeared strongest among patients with five comorbidities and those discharged to facilities, indicating that financially vulnerable and clinically complex patients may be most at risk.<br /><br />Overall, the study concludes that high cost-sharing may unintentionally increase readmissions after COPD hospitalization. The authors recommend considering financial burden in insurance design, discharge planning, and post-discharge care to help protect vulnerable patients.

Asset Subtitle

James D. Lee

Meta Tag

Author List James D. Lee, Mark Fendrick, Nora v. Becker

Category Research

Concept Chronic Obstructive Pulmonary Disease

Concept Hospital Readmission

Concept Out-of-Pocket Cost

Concept Instrumental Variable

Concept Deductible Reset

Distinguished Non-Finalist

Presenter Organization University of Michigan

Presenting Author James D. Lee

Track Other

Keywords

COPD hospitalization

out-of-pocket costs

readmission risk

commercial claims data

January deductible reset

instrumental variable design

six-month readmission

cost-sharing

patient financial burden

post-discharge care

Chronic Obstructive Pulmonary Disease

Hospital Readmission

Out-of-Pocket Cost

Instrumental Variable

Deductible Reset