Welcome to Lesson 3 of ACC's Heart Failure Accreditation Overview Course. This learning activity was developed by myself. I am Liza St. Clair, and I will also be narrating this presentation. The purpose of this lesson is to provide an understanding of the challenges of healthcare providers and the strains within the healthcare industry to manage the heart failure population. Our objectives for this lesson will be to demonstrate the rise in cost of caring for the heart failure population, reviewing reimbursement penalties, and identify opportunities to manage and control these expenses and resources. Providing optimal care and medical therapy is threatened by increasing pressures of high quality, patient satisfaction, and costs. These factors are challenging obstacles we need to overcome to provide the delivery of healthcare. We consistently see a suboptimal quality of care being delivered, resulting in low patient satisfaction or a public perception that quality is low along with an incredible rise in cost for healthcare in this country. So how can we improve? Currently, within a 30-day period, CMS will spend between $15,000 to $19,000 per heart failure case. With a growing heart failure population and subpar care, the cost is only going to go up if we do not improve the processes and manner in which we care for these patients. The projected increase in direct and indirect costs attributable to heart failure from 2012 to 2030 is displayed. Indirect costs and costs of medical care are expected to increase at a faster rate than indirect costs because of the loss of productivity and early mortality. In 2012, the cost of heart failure was at its highest and estimated to be at $30.7 billion. In addition, hospitals were suffering from penalties through value-based purchasing and hospital readmission reduction programs, which, of course, that focus was to reduce 30-day readmissions, length of stay, and inpatient mortality. However, we still see the rising aging population and increased Medicare spending. As shown, costs are approaching approximately $43 billion a year and expected to rise to $70 billion by 2030. The cost of cardiovascular medication is the second most important factor for heart failure patients. After hospital costs, this accounts for almost 16% of direct costs. Therefore, strategies for managing the delivery of care to the heart failure population must include labs and imaging tests and communication of those results to clinicians managing care for that patient. Considering the limitations and medical coverage, for example, we may need to consider if a subsequent echo is truly warranted, utilizing generic medications, working with pharmacy to reduce the number of medications and costs, in addition to utilizing assistance or discount programs to obtain these medications, developing non-emerging outpatient strategies, collaborating with patient and family to ensure we meet the needs of the patient, and also being aware of community resources that are available that have little or no cost. This should look familiar to anyone who's managed heart failure patients. This is the vicious cycle that many heart failure patients get caught in when suboptimal care, symptom management, and guideline-directed medical therapy are provided. A patient who presents to the physician's office with worsening heart failure symptoms and in severe volume overload will not be able to be managed in the outpatient setting. If the physician is a primary care doctor and does not have the resources to meet the needs of the patient, they will likely be sent to the ED and get admitted to the hospital on an inpatient unit. So now this results in a costly hospital admission, which could have been avoided if the signs and symptoms were recognized sooner and an intervention was sought sooner. In addition, if the patient is not identified as a heart failure patient, then the patient does not get prescribed guideline-directed medical therapy, does not receive the appropriate patient education, and is sent home without the proper resources. The patient is then discharged, still not optimized, and without the tools and medication necessary to be successful with their disease, which will now then perpetuate the patient going back into the cycle, still symptomatic at home, showing up at the physician's office, being poorly managed due to an inaccurate diagnosis, and that patient being readmitted again. In achieving heart failure accreditation, the goal is to implement interventions to improve the quality of care, better identification, improving the continuum of care, creating improved clinical pathways so that caring for these patients will be successful. Another example linking the aforementioned slide is that increased hospitalizations is equal to decreased survival when discharged from the hospital. The median survival rate after hospitalization is poor. This illustrates that every time a patient is admitted, it will result in poorer outcomes. Increased hospitalizations without having a proper pathway will lead to negative effects of the patients and will speed up the progression of their disease. However, strides must be made towards other performance initiatives beyond just reducing a facility's 30-day readmission rate. A heart failure program will also need to address length of stay, patient mortality, patient satisfaction, process of care measures, and efficiency, as these are factors that are attributed to CMS's Hospital Value-Based Purchasing Program. By doing poorly in these areas will result in an estimated 2% penalty or reduction in payment from CMS, but it's important to remember that targeting just one of these factors, for instance, may negatively affect another outcome. For example, if the focus is to reduce length of stay, how can that be done effectively without impacting process measures or compromising the patient's risk for readmission? Therefore, it is important to evaluate the heart failure program as a whole and consider a truly comprehensive approach to improve all outcomes and not just one. This concludes Lesson 3 of 4. Thank you for your participation.

heart failure population

rising costs

reimbursement penalties

care delivery optimization

comprehensive approaches