Heart Failure is a chronic, progressive condition where the heart muscles are unable to pump sufficient amounts of blood to meet the body’s need for blood and oxygen causing the heart to overwork. This patient population is at a higher risk of hospital readmission compared to
other chronic conditions due to its significant mortality rate and poor prognosis. According to the Centers for Disease Control and Prevention (CDC), approximately 6.5 million adults in the United States have Heart Failure (HF), with an increase to 8.5 million by 2030. In the last three
years, Heart Failure was a contributing factor to every 1-in-8 deaths while costing the nation an estimate of $30.7 billion in health care services, medications, hospital readmissions (U.S. Department of Health & Human Services, 2019). Patients with heart failure experience changes
in their quality of life and overall well-being, therefore it is important that we learn how to modify patient outcomes by suggesting and implementing interventions that exhibit continuum of care. However, it is equally important to measure the effectiveness and sustainability of these interventions on how well they can identify patients at high risk of rehospitalization (Shams et al., 2014, p. 19).
To overcome that bridge, the Centers for Medicare & Medicaid Services (CMS) introduced one such intervention, Hospital Readmissions Reduction Program (HRRP), a Medicare value-based purchasing program to reduce payments to hospitals with excess readmissions. This intervention is geared towards supporting “the national goal of improving healthcare for Americans by linking payment to the quality of hospital care” (“Hospital Readmissions Reduction Program (HRRP),” 2020). Throughout, the remainder of this paper we will discuss several transitional care interventions and elaborate on the program(s) and incentives set by CMS to reduce the 30-days hospital readmission rates for patients with heart failure.
For this population health intervention project, the selected population data will be carried out utilizing data from the national 5% sample of Medicare beneficiaries from the Chronic Conditions Warehouse which is the national repository for CMS data. (Kilgore et al., 2017, p. 64). The population included individuals aged ≥65 years with at least one inpatient (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnosis code of HF as the primary diagnosis. For the purpose of this project, the definition of HF includes left ventricular, right ventricular, combined and unspecified HF. To analyze the rate, cost, and length of stay of hospitalizations, the population edibility criteria also included patients with a minimum of six (6) month enrollment under Medicare Part A and B prior to the index date
and 36 months of continuous enrollment following the index month. Index date is defined by the first observed HF-associated hospitalization (Kilgore et al., 2017, p. 63-64).
HF is a complex and collective clinical condition which results from any functional or structural cardiac impairment simultaneous with “comorbidities, which frequently include hypertension and coronary artery diseases. Cardiac dysfunction in HF is often described using values of cardiac output (Q), stroke volume (SV), or resting EF% which are abnormally low and may be useful for estimating syndrome severity and prognosis (Snyder et al., 2015, p. 207). According to the article, Two types of heart failure, (2015) the two forms of HF are systolic and diastolic differentiated based on ejection fraction (the amount of blood the heart pumps out with each contraction). A normal ejection fraction is about 55 to 65 percent, with that in mind, Systolic HF is diagnosed when the left ventricle becomes large and contracts so feebly that its blood is not expelled throughout the circulatory system efficiently; individuals with this condition have ejection fractions of 10 to 55 percent. On the other hand, diastolic heart failure is when the heart’s pumping strength is preserved, and the ejection fraction is normal. However, the ventricles don’t relax properly, which meaning they heart does not have sufficient time to fill effectively (pg. 6). As discussed earlier, currently HF affects 1-2% or approximately 6. 5 million of the general population and over 800,000 new cases are diagnosed annually. The prevalence is on a rise with an estimated increase to 8.5 million by 2030 (U.S. Department of Health & Human Services, 2019); all of which leads to increased levels of morbidity and mortality rates, decreased quality of life and increased care costs. “HF patients are particularly vulnerable to readmission; all-cause readmission rates have been repo
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