This Figure illustrates a number of the different factors analyzed by the BIM and how they apply to each of the different stakeholders.  For example, the frequency of readmissions, mortality, and dropouts has an impact for the hospital because there are patients who are being readmitted to the hospital.  When they die they are not being readmitted to the hospital, and likewise, when they drop out, their readmission to the hospital is different than it would be if they were still receiving therapy.

From a DME provider’s perspective, they are not reimbursed based on the readmission; therefore readmission rates do not apply to the DME perspective. Readmission rates are obviously critical from the payer perspective, however, as the payers are providing that reimbursement.  On the other hand, both mortality and dropout rates would be important variables for both DME providers and payers.

The analysis also looked at costs, specifically the cost to the hospital for a readmission of a severe COPD patient, the cost of sleep studies in situations where they are needed, and the cost of the device acquisition.  For example, the ventilator is a cost that the DME provider will incur, in addition to costs for supplies and supportive care, as well as a set up cost.  From a reimbursement perspective, the hospital receives reimbursement for readmissions, as well as for the sleep study, so that applies to both the hospital and the payer.  Device acquisition is reimbursed to the DME provider by the payer, as well as supplies and supportive care for select devices.