Hospital discharge is one of the most critical handoffs in a patient’s journey. And for medically complex patients with Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), or neuromuscular conditions, the days following a hospital stay are often the most fragile, and most overlooked.
On paper, a discharge might look seamless: oxygen ordered, non-invasive ventilation (NIV) prescribed, enteral therapy in motion.
But in practice?
- The oxygen arrives two days late.
- The patient doesn’t understand how to use their mask.
- Additional supplies (e.g., masks, tubing, nebulizer kits) never show.
- No one follows up.
Each delay or missed connection increases the risk of readmission, a frustrating experience for patients and providers alike. Nearly 1 in 5 Medicare patients are readmitted within 30 days, and a significant portion of those readmissions are considered preventable.¹
At Rotech, we believe preventable readmissions should be just that: prevented. Below, we break down how Rotech’s coordinated clinical programs help hospital teams improve discharge outcomes, reduce post-acute risk, and support long-term patient stability at home.
Why Respiratory Patients Are Especially High-Risk
Patients with chronic or acute respiratory needs face unique challenges during the transition from hospital to home:
- Therapy adherence is complex. Patients may be prescribed oxygen, CPAP, BiPAP, nebulizers, NPWT, or ventilator therapy, often in combination.
- Setups can be delayed. Lack of coordination or backlogs in supply delivery can mean a critical window is missed.
- Education is inconsistent. Patients may not know how to manage their equipment or when to seek help.
- Follow-up is fragmented. Without structured accountability, early warning signs are often missed.
These breakdowns disproportionately affect high-risk patients, especially those with COPD, CHF, obesity hypoventilation syndrome (OHS), and neuromuscular conditions. If not addressed swiftly, they can lead to worsening symptoms, complications, and avoidable hospital returns.2
Rotech: A Trusted Partner in Post-Acute Respiratory Transitions
Rotech offers a unique advantage to hospitals and discharge teams: nationwide scale with local, personalized clinical support.
- 300+ locations across the U.S.
- 24–48 hour setup turnaround in most areas
- Dedicated discharge coordination teams
- Clinical oversight for complex therapies
- Streamlined referrals (one call, one partner)
- Ongoing patient monitoring and education
Whether you’re transitioning a patient from ICU or managing long-term ventilator needs, Rotech delivers continuity of care beyond the discharge doors. Refer a patient to Rotech Healthcare today.
Clinical Programs That Close the Gaps
Rotech offers several targeted programs designed to help reduce hospital readmissions by improving setup speed, therapy adherence, and post-discharge education. These programs are built to support specific patient populations with complex respiratory needs.
1. COPDBridge™ – Helping COPD Patients Succeed Post-Discharge
COPD exacerbations are among the leading causes of 30-day hospital readmissions.3 Rotech’s COPDBridge™ program supports patients during the critical first 30 days at home.
What It Includes
- COPD-specific follow-up care and education
- Supply and therapy verification
- Symptom coaching to detect and report flare-ups early
- Seamless coordination with the prescribing provider
Program Impact
COPDBridge™ helps patients stay adherent, confident, and connected to their care plan, which means fewer ER visits, better outcomes, and higher satisfaction.
2. NIVNow™ – Rapid Setup for Non-Invasive Ventilation Patients
Starting non-invasive ventilation (NIV) at home after hospitalization? Delays or improper setups can seriously compromise outcomes.
NIVNow™ accelerates setup and surrounds both patients and caregivers with support from day one.
What It Includes
- Fast-tracked setup of BiPAP/ST or AVAPS
- In-home or remote mask fitting and clinical education
- Ongoing respiratory therapist support
- 24/7 troubleshooting and escalation pathway
Program Impact
Timely NIV initiation post-hospitalization has been shown to:4
- Be associated with reduced mortality
- Improve ventilation adherence
- Decrease 30-day readmission rates for COPD with chronic hypercapnia
3. CarePLUS™ – Coordinated Home Therapy for Complex Patients
For patients with multiple comorbidities, fragmented home care is one of the biggest readmission risks.
CarePLUS™ brings together all necessary therapies into one integrated home plan.
What It Includes
- Centralized referral and equipment delivery
- Cross-checks across therapies to prevent gaps
- Caregiver and patient training across modalities
- Remote clinical oversight and escalation support
Provider Impact
- One point of contact for multiple services
- Lower readmissions through coordinated interventions
- Reduced burden on hospitalists and discharge teams
- Improved patient continuity across the care journey
What This Means for Hospitals, Case Managers, and Referral Coordinators
Why Choose Rotech?
You don’t just need a DME vendor — you need a clinical partner who helps your team:
- Discharge patients with confidence and continuity
- Improve outcomes without overburdening staff
- Avoid penalties tied to preventable readmissions
- Spend less time managing logistics and more time delivering care
We’re here to be that national partner in value-based respiratory care that you can rely on.
What We Offer
Rotech makes it simple to match the right patient to the right program, at the right time.
- Single-point referral process for oxygen, NIV, wound care, enteral nutrition, and more
- Rapid response teams for urgent setups
- Insurance verification and prior authorization support
- HIPAA-compliant documentation and updates
Not sure if your patient qualifies? Our local reps and respiratory clinicians are here to help.
Let’s Prevent the Preventable
Hospital bounce-backs affect more than just your metrics; they affect your patients. That’s why Rotech is committed to helping your team close the gaps between discharge and stability at home.
With programs like COPDBridge™, NIVNow™, and CarePLUS™, we empower hospitals to reduce preventable readmissions and improve outcomes for your most vulnerable respiratory patients.
Let’s talk about your care coordination goals for 2026, and how we can support them.
References
1 Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., Wang, Z., Erwin, P. J., Sylvester, T., Boehmer, K., Ting, H. H., Murad, M. H., Shippee, N. D., & Montori, V. M. (2014). Preventing 30-Day Hospital Readmissions. JAMA Internal Medicine, 174(7), 1095. https://doi.org/10.1001/jamainternmed.2014.1608
2 CMS. (2024). Hospital readmissions reduction program (HRRP) . Www.cms.gov. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp
3 Larsen, D. L., Gandhi, H., Pollack, M., Feigler, N., Patel, S., & Wise, R. A. (2022). The Quality of Care and Economic Burden of COPD in the United States: Considerations for Managing Patients and Improving Outcomes. Www.ahdbonline.com, 15(2), 57–64. https://www.ahdbonline.com/articles/3223-the-quality-of-care-and-economic-burden-of-copd-in-the-united-states-considerations-for-managing-patients-and-improving-outcomes
4 Ankjærgaard, K. L., Maibom, S. L., & Wilcke, J. T. (2016). Long-term non-invasive ventilation reduces readmissions in COPD patients with two or more episodes of acute hypercapnic respiratory failure. European Clinical Respiratory Journal, 3(1), 28303. https://doi.org/10.3402/ecrj.v3.28303