Of patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), one in five will require re-hospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based healthcare. In the US, COPD is part of Medicare’s Hospital Readmission Reduction Program (HRRP), penalizing hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions. This review outlines challenges for improving overall COPD care quality and specifically for the HRRP. These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the target population during hospitalizations, and a lack of literature to guide evidence-based programs for COPD readmissions as defined by the HRRP in the hospital setting. This review then identifies risk factors for early readmissions after acute exacerbation of COPD (AECOPD), and discusses tested and emerging strategies to reduce these readmissions. Finally, we evaluate the current HRRP and future policy changes and their effect on the goal to deliver value-based COPD care. COPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policymakers, but we still have a long way to go to truly deliver value-based care to our patients.