Told by the numbers, the story of heart failure startles even experienced health care leadership.
Behind the numbers, of course, are real human beings with serious medical conditions. These patients want and need to avoid hospitalization just as much as their doctors and other care providers want to keep them out of the inpatient setting.
“Historically, heart failure has been one of the least well-managed conditions,” said David Laird, CEO of Heart Hospital of Austin in Texas. “However, we can change that by providing the highest quality of clinical services and by proactively managing readmissions.”
That has been easier said than done.
“Part of the challenge [in managing] heart failure is predicting when these patients will end up in the hospital,” said Kunjan Bhatt, MD, director of heart failure for Austin Heart. “In the past, there has been no good way to anticipate changes in patient status before heart failure symptoms emerge.” And once a patient shows up at the emergency room with fluid in the lungs, doctors are already playing catch-up.
The complexity and magnitude of heart failure's economic burden has also resulted in a series of financial reform programs from the Centers for Medicare and Medicaid Services (CMS). These programs, called the Hospital Value-Based Purchasing and Readmissions Reduction programs, penalize and sometimes incentivize facilities based on benchmarked mortality and readmission rates, as well as a hospital's per-patient costs across 30 days of care. Since heart failure has a high ratio of discharges per patient (1.26) over a one-year period, hospitals that cannot effectively manage these patients could carry significant financial risk.
In this environment, technology partners must develop groundbreaking solutions with health care providers focused on reducing the need for costly admissions and readmissions. St. Jude Medical (SJM) is one such company that has pioneered innovations such as the Quadra™ CRT System and CardioMEMS™ HF System, both of which have demonstrated to drastically improve clinical and fi nancial outcomes.5,6,7,9,10,12
“We understand that health care providers are looking for technological breakthroughs that allow them to better manage the complex care of patients and lower the cost and risk associated with treating them,” said Mark Carlson, MD, Chief Medical Offi cer of St. Jude Medical. “We are focused on partnering with health care providers to search for new ways to meet the growing needs for innovative solutions that truly deliver value through improved care and reduced costs.”
Across the country, hospitals and physician groups are putting together new strategies that combine processes and people with emerging technologies to keep heart failure patients healthy. By partnering with medical technology providers and implementing best practices, health care institutions can create heart failure-focused programs that reduce hospitalizations, readmissions and mortality—programs that may also help providers avoid Medicare readmission penalties.