Reimbursement policy has been a driver of change in the way hospitals handle heart failure patients.
When CMS started penalizing hospitals that readmitted too many patients within 30 days of discharge, heart failure patients were those most in need of attention. These patients tend to be older with other health issues, and under the traditional fee-for-service payment systems, there was little incentive to find ways to keep them from coming back after discharge.
By 2015, 30-day readmission was a $17 billion problem for Medicare and Medicaid and heart failure was the most common cause. It’s a problem tied to socioeconomic factors, but that’s not the whole story: current estimates find about 20% of heart failure patients are readmitted within 30 days and 50% within 6 months.
But hospitals can turn things around quickly with the right approach. At the 2017 American Heart Association (AHA) Scientific Sessions, Amar Bhakta, MD, of Rush University Medical Center in Chicago, Illinois, presented results from his hospital’s clinical pathway for heart failure. Preventing readmissions starts the moment the patient enters the emergency department, and involves a multidisciplinary team, help from outside the hospital, and most of all, a plan to ensure follow-up with the patient’s primary care physician.
A chart review for 2016 shows the results: From January 1, 2016, to June 30, 2016, before the pathway took effect, the 30-day readmission rate for heart failure patients was 22.5% (88 of 393 patients). From July 1, 2016, through December 31, 2016, the rate was 16.6% (66 of 367 patients).
Rush’s pathway involves professionals from across the health system: social workers nurses, nurse practitioners, pharmacists, physicians, hospitalists, heart failure physicians, and administrators. The pathway features standardized admission orders, specific medications, heart failure consult criteria, and criteria for admission to the cardiac intensive care unit, which were included in the abstract presented at AHA. The detailed chart spells out when additional consults with the heart failure specialists occur, what happens if patients gain or lose weight, and what to do given certain renal outcomes.
The critical element of the pathway is the follow-up process: patients leave the hospital with plans to see a nurse practitioner within 7 days of discharge and their PCP within 3 weeks. In an interview with The American Journal of Managed Care®, Bhakta said for the population that Rush serves, this second part isn’t always easy. But the focus shows in the results: the mean time to follow-up fell from 13 days, (±1.51 days) in the first 6 months of 2016 to just 8 days (±0.92 days) in the second 6 months.
Changing reimbursement models are driving much of the change, Bhakta said.
“It’s getting most hospitals into a different way of thinking, not just from a reimbursement perspective, but also from a patient-centered perspective,” he said. “Patients don’t want to be readmitted if they’re experiencing symptoms. If hospitals aren’t being reimbursed, whatever can be done in an appropriate way should be done.”
Reference
Moseley A, Accavitti MJ, Bhakta A, et al. Reducing heart failure readmissions using a multidisciplinary approach. Presented at the 2017 American Heart Association Scientific Sessions, Anaheim, California; November 11-15, 2017. M4062.
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
POSITIVE Trial Update on Patients With Breast Cancer Attempting Pregnancy
December 8th 2023At last year’s San Antonio Breast Cancer Symposium, POSITIVE trial primary outcome data were presented on breast cancer–free interval, with women who paused endocrine therapy to attempt pregnancy having a similarly small rate of recurrence vs external controls from the SOFT and TEXT trials: 8.9% vs 9.2%.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
New Insights on Breast Cancer Outcomes Among Sexual, Gender Minorities
December 7th 2023Despite there being a great demand for data collection on sexual orientation and gender identity in the cancer space, individuals who identify as a sexual and gender minority remain poorly represented.
Read More
Patients With HFrEF, HFpEF See Different Functional Capacity Benefits With Dapagliflozin
December 7th 2023The DETERMINE-Reduced and DETERMINE-Preserved trials demonstrated varying benefits of dapagliflozin on Kansas City Cardiomyopathy Questionnaire Total Symptom Score and Physical Limitation Scale as well as 6-minute walk distance.
Read More