Aggressive Post-Acute Care Needed for Medicare Patients with Heart Failure


Fee-for-Service Medicare beneficiaries with heart failure accounted for 55.3% of readmissions.

A new study has found that heart failure patients insured by Medicare have high admission and readmission rates, which creates significantly higher costs compared with Medicare patients without heart failure.

The study, published in American Health & Drug Benefits, used the 2011 to 2012 Medicare 5% sample to examine the utilization and cost of admission and readmission for patients with heart failure. Included was data from approximately 1.5 million patients with traditional fee-for-service Medicare.

There were approximately 1.3 million patients without heart failure and 160,390 with heart failure. Researchers analyzed Part A and B claims to find that the Medicare-allowed cost per member per month (PMPM) was $3395 for patients with heart failure and $1045 PMPM for all Medicare patients.

According to the study, the costs generated from patients with heart failure accounted for 34% of the annual Medicare FFS population-allowed costs. Researchers also found that 41.5% of inpatient admissions and 55.3% of readmissions were patients with heart failure.

Approximately 49.5% of admissions to nursing facilities were from this group of patients, as well. Researchers also found the all-cause 30-day readmission rate for patients with heart failure was 28% compared with 21% in patients without heart failure.

Several Medicare programs have been found to reduce inpatient utilization and costs, but they are newly implemented so their full effect is not known, according to the study.

Researchers concluded that hospitals should focus on aggressive post-acute care management in these patients in order to reduce readmission and, consequently, costs for this population.

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