Skip to main content

Advertisement

Log in

Emerging Trends in Health Care Costs and Reimbursement for Heart Failure

  • Heart Failure (F Peacock and L Zhang, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Escalating costs threaten to destabilize the US health care system. This review evaluates the overall economic burden of heart failure in the USA and new payment models that attempt to address rising costs.

Recent Findings

The aging population and improved outcomes with innovative treatments for heart failure are likely to result in a continued increasing economic burden. Recent cost estimates and economic models suggest that prior studies might have substantially underestimated the total costs related to heart failure. CMS is leading the efforts to design alternative payment systems that shift from rewarding volume of care to rewarding quality and improved outcomes with an emphasis on global integrated care payments.

Summary

Providers of care to heart failure patients may be required to accept lower overall payments. Economic viability will require collaborative and efficient evidence-based quality care delivery models.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Commins J. Nearly 205 of GDP to be spent on healthcare in 2020. Health Leaders Media. July 28, 2011 http://www.healthleadersmedia.com/health-plans/nearly-20-gdp-be-spent-healthcare-2020?nopaging=1 (Accessed October 29, 2016).

  2. Roger VL. Epidemiology of heart failure. August 2013. http://circres.ahajournals.org/content/113/6/646 (Accessed December 4, 2016).

  3. Horwich TB, Fonarow GC. Glucose, obesity, metabolic syndrome, and diabetes. Relevance to incidence of heart failure. J Am Coll Cardiol. 2010;55:283–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mozzafarian D, Benjamin EJ, Go AS, et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e360. (Accessed November 26, 2016)

    Article  Google Scholar 

  5. •• Heart Disease and Stroke Statistics 2015 Update. http://circ.ahajournals.org/ (Accessed February 22, 2016). This article presents the most recent overall statistics on heart disease and heart failure and costs of cardiovascular diseases in the USA and provides a basic framework for discussion of economic burden.

  6. Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J. 1997;133:703–12.

    Article  CAS  PubMed  Google Scholar 

  7. Peacock WF, Albert NM. Observation unit management of heart failure. Emerg Med Clin North Am. 2001;19:209–32.

    Article  PubMed  Google Scholar 

  8. Bueno H, Ross JS, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA. 2010;303(21):2141–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Desai, AS, Stevenson LW. Rehospitalization for heart failure. Predict or Prevent? http://circ.ahajournals.org/content/126/4/501.full (Accessed February 22,2016)

  10. Centers for Disease Control and Prevention. National Center for Health Statistics 2010 National Ambulatory Medical Care Survey.www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm (Accessed February 21, 2016).

  11. Mozzafarian D, Benjamin EJ, Go AS, et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e360. (Accessed November 26, 2016)

    Article  Google Scholar 

  12. American Hospital Directory analysis of CMS outpatients claims.

  13. Blecker S, Ladapo J, Doran K, Goldfeld K, Katz S. Abstract 204: emergency department visits for heart failure and subsequent hospitalization or observation unit admission circulation: cardiovascular quality and outcomes. Am Heart J. 2014;168(6):901–908 e1.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Blecker S, Ladapo J, Doran K, Goldfeld K, Katz S. Abstract 204: emergency department visits for heart failure and subsequent hospitalization or observation unit. Admission Circulation: Cardiovascular Quality and Outcomes. 2014;7:A204.

    Google Scholar 

  15. • Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–19. (Accessed November 26, 2016).Overall review of heart failure associated costs of care prior to 2016 update

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mozzafarian D, Benjamin EJ, Go AS, et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–e360. (Accessed November 26, 2016)

    Article  Google Scholar 

  17. •• Voigt J, Sasha JM, Taylor A, et al. A reevaluation of the costs of heart failure and its implications for allocation of health resources in the United States. Clin Cardiol. 2014;37(5):312–21. Evidence presented that suggests previously reported costs related to heart failure may substantially underestimate the true burden to the US health care system. The analysis herein updates cost estimates based on costs involved in overall comorbid conditions as well.

    Article  PubMed  Google Scholar 

  18. Accountable Care Organizations: Frequently Asked Questions and Research Summary Revised January 31, 2013.http://c0024345.cdn1.cloudfiles.rackspacecloud.com/LegislativeDownload.pdf (Accessed March 2, 2016).

  19. Chan DC, Heidenreich PA, et al. Heart failure disease management programs: a cost-effectiveness analysis. Amer Heart J. 2008;155:332–8.

    Article  PubMed  Google Scholar 

  20. Miller G, Randolph S, et al. Long-term cost-effectiveness of disease management in systolic heart failure. Med Decis Mak. 2009;29:325–33.

    Article  Google Scholar 

  21. • Schroettner J, Lassnig A. Simulation model for cost estimation of integrated care concepts of heart failure patients. Health Economics Review. 2013;3:26 www.healtheconomicsreview.com/content/3/1/26. This article shows the details of a broad based economic model for evaluating potential scenarios to compare clinical and cost outcomes and reimbursement strategies of a variety of treatment interventions based on integrated care. In clinical practice, several treatment interventions occur simultaneously. In today’s economically driven health care discussions, it will become increasingly important to be able to determine which specific interventions offer the most beneficial outcomes for the resources invested.

  22. Gregory D, Kimmelsteil C, et al. Hospital cost effect of a heart failure disease management program: the Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) trial. Am Heart J. 2006 May;15(5):1013–8.

    Article  Google Scholar 

  23. Lucas BP, Kumapley R, et al. A hospitalist-run short stay unit: features that predict length-of-stay and eventual admission to traditional inpatient services. J Hosp Med. 2009;4(5):276–84.

    Article  PubMed  Google Scholar 

  24. Hospitals’ use of observation stays and short inpatient stays for Medicare beneficiaries. https://oig.hhs.gov/oei/reports/oei-02-12-00040.pdf (Accessed November 28, 2016)

  25. Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year; Christopher W. Baugh, Arjun K. Venkatesh, Joshua A. Hilton, Peter A. Samuel, Jeremiah D. Schuur and J. Stephen Bohan6. http://content.healthaffairs.org/content/early/2012/09/20/hlthaff.2011.0926(Accessed April 1, 2016)

  26. Collin SP, Schauer DP, et al. Cost-effectiveness analysis of ED decision-making in patients with non-high-risk heart failure. Am J Emerg Med. 2009;30:293–302.

    Article  Google Scholar 

  27. Diercks DB, Peacock F, et al. ED patients with heart failure: identification of an observational unit-appropriate cohort. Am J Emerg Med. 2006;24:319–24.

    Article  PubMed  Google Scholar 

  28. •• Hospital value-based purchasing.https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html (Accessed March 1, 2016). This reference highlights the current CMS movement toward value-based reimbursements. CMS often represents the driving force in new reimbursement patterns, many of which are subsequently adopted by private insurers.

  29. Cys J. Accountable care organizations. A new idea for managing Medicare. American Medical News 2009;www.ama-assn.org/amednews/2009/08/31/gvsa0831.htm (Accessed March 2, 2016)

  30. •• Better, Smarter, Healthier: in historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. January 26, 2015 http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html (Accessed March 5, 2016). Outlines CMS’ move toward changing reimbursement models from paying for volume of care to models that pay based on quality of care delivered. This movement represents the first time Medicare has outlined such aggressive future payment alternatives and is a harbinger of changes to come.

  31. Comprehensive care for joint replacement. https://innovation.cms.gov/initiatives/cjr (Accessed February 28, 2016).

  32. Graff LG. Observation medicine. The Healthcare System’s Tincture of Time.

  33. Overview of CMS readmission penalties for 2015. http://www.besler.com/2015-readmissions-penalties/.

  34. CMS will withhold more than $500 million in payments under its readmission reduction program. August 2016. Accessed December 3, 2016).

  35. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html (Accessed November 19, 2016).

  36. The $272 billion Swindle. Why thieves love the American health-care system. May 2014. http://www.economist.com/news/united-states/21603078-why-thieves-love-americas-health-care-system-272-billion-swindle (Accessed December 2, 2016).

  37. CMS to unveil proposed regulations to combat health program fraud. California HealthCare Foundation http://www.californiahealthline.org/articles/2010/9/20/cms-to-unveil-proposed-regulations-to-combat-health-program-fraud.aspx#ixzz1067vyvsj.

  38. Uncertain fate of health law giving health industry heartburn. Kaiser Health News. http://www.healthleadersmedia.com/health-plans/uncertain-fate-health-law-giving-health-industry-heartburn (Accessed November 21, 2016).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sandra Sieck.

Ethics declarations

Conflict of Interest

Dr. Sieck declares no conflicts of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sieck, S. Emerging Trends in Health Care Costs and Reimbursement for Heart Failure. Curr Emerg Hosp Med Rep 5, 76–82 (2017). https://doi.org/10.1007/s40138-017-0130-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-017-0130-9

Keywords

Navigation