Prevent Heart Failure Readmissions and Improve Quality
5.7 million American adults live with heart failure. (Ziaeian & Gregg, 2016)
One million hospitalizations for heart failure occur annually (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013)
70% of heart failure readmissions are for non-heart failure diagnoses, most commonly other cardiovascular conditions, pulmonary disease, and infections (Davis, et al., 2017)
There are 500,000 new cases of heart failure each year in the United States. (Ogah, 2017)
Heart failure will increase 46% from 2012 to 2030, with greater than 8 million adults living with the chronic condition.
Reimbursement Penalties in Full Force
Hospitals addressing readmissions performance must act quickly. CMS uses three full years of data to determine penalties, so hospitals need to document and report positive performance data as quickly as possible to cycle it into the three-year rolling sample.
The full 3 percent penalties for reimbursement are now in force. The reduced payments apply to all their Medicare admissions—not just those that resulted in readmissions.
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Patient and Healthcare Impact
Davis, J. D., Olsen, M. A., Bommarito, K., LaRue, S., Saeed, M., Rich , M. W., & Vader, J. M. (2017). All-Payer Analysis of Heart Failure Hospitalization 30-Day Readmission: Comorbidities Matter. The American Journal of Medicine, 130(1), 93.e9-93.e28. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482409/
Fitch, K., Engel, T., & Lau, J. (2017). The Cost of Worsening Heart Failure in the Medicare Fee For Service Population: An Actuarial Analysis. Milliman, 1-29. Retrieved from http://us.milliman.com/uploadedFiles/insight/2017/cost-bruden-worsening-heart-failure.pdf
Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization for Heart Failure. Journal of American College of Cardiology, 61(4), 391-403. Retrieved from https://www.sciencedirect.com/science/article/pii/S0735109712052965?via%3Dihub
Ogah, O. A. (2017). Heart Failure: Definition classification, and pathophysiology - a mini-review. Nigerian Journal of Cardiology, 14(1), 9. Retrieved from http://www.nigjcardiol.org/citation.asp?issn=0189-7969;year=2017;volume=14;issue=1;spage=9;epage=14;aulast=Adebayo;aid=NigJCardiol_2017_14_1_9_201913
Ziaeian, B., & Gregg, F. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in Cardiovascular Disease, 58(4), 379-385. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783289/