Last Modified: 10/27/2023
Location: FL, PR, USVI
Business: Part A, Part B
First Coast is exploring innovative ways we can help reduce disparities in healthcare delivery and utilization by developing solutions that equip Medicare participating providers with the ability to tailor their care to meet the unique needs of their respective communities.
Throughout 2022 - 2023, First Coast will identify Medicare providers servicing beneficiaries with COPD to voluntarily participate in this project. Our focus with this initiative is to achieve the following:
• Deploy a collaborative approach between the MAC and Medicare providers to improve beneficiary health outcomes
• Distribute and monitor utilization statistics associated with preventive and screening services
• Conduct outreach to spread awareness of health outcome improvements through early treatment intervention and proactive use of preventive and/or screening services covered under the Medicare benefit
• Identify and engage community-level resources to also assist with removing common accessibility barriers resulting in unnecessary care deficits, such as transportation
COPD refers to a group of diseases that cause airflow blockage and breathing-related problems. In 2018, COPD was the fourth leading cause of death in the US with almost 15.7 million Americans diagnosed with the disorder. More than 50% of adults with low pulmonary function were not aware they had COPD, so many adults are undiagnosed and experience a lack of treatment as a result.
COPD is often preventable and treatable. Early and frequent intervention through medications, oxygen therapy, pulmonary rehabilitation, and social support help to manage the disease.
Medicare covers Pulmonary Rehabilitation (PR) Program services for patients with chronic respiratory impairment. PR services include:
• A multi-disciplinary program that is individually tailored and designed to optimize physical and social performance and autonomy
• Evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities
Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to:
• Reduce symptoms
• Optimize functional status
• Increase participation
• Reduce health care costs through stabilizing or reversing systematic manifestations of the disease
Beneficiaries with a history of COPD may be at particular risk for missing critical preventive services, which could place the beneficiary at potential risk for increased morbidity and decreased quality of life. Medicare covers the following preventive service benefits (not an all-inclusive list):
• Annual Wellness Visit (AWV) - includes a personalized prevention plan designed to prevent disease and disability based on your patient's current health and risk factors
• Initial Preventative Physical Examination (IPPE) - also known as the "Welcome to Medicare" preventative visit; the goals of the IPPE are health promotion, disease prevention, and early detection
• Depression screening
• Smoking cessation resources
• Lung cancer screening
For a full listing of Medicare covered preventive services, visit CMS' Preventive Services center.
For your convenience we're providing a printer friendly COPD fact sheet
to promote preventive services to your patients.
• Economic disparities in health outcomes, utilization and/or spending
• Chronic disease prevalence rates within a geographic location
• Hospital and emergency department utilization
• Readmission and mortality rates
CMS' Framework for Health Equity
is an initiative focused on advancing health equity, expanding coverage, and improving health outcomes for individuals supported by CMS programs. Components of the framework include:
• Infographic listing the 5 Key Objectives to help rural health providers support their patients
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.