Heart Failure Practice Improvement Effort in the Outpatient Setting: A Health Care Financing Administration Initiative to Improve the Care of Medicare Beneficiaries with Heart Failure

In fiscal year 2003, Medicare beneficiaries with heart failure (HF) accounted for 37% of all Medicare spending and nearly 50% of all hospital inpatient costs. On average, each beneficiary had 10.3 outpatient and 2 inpatient visits specifically for HF. Despite significant improvements in medical care for HF, mortality and hospital admissions remain high. No data exist regarding the number of providers ordering and providing care for this population. An analysis of fiscal year 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF employing the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. We identified physicians by using the unique physician identification number of performing physicians. Based on inclusion criteria, 173,863 beneficiaries were identified. The average number of providers providing care in all sites were 15.9, 18.6, 23.1 for beneficiaries with mild, moderate, and severe HF, respectively; and 10.1, 11.5, and 12.1 in the outpatient setting, respectively. The average number of providers ordering care in all sites consisted of 8.3, 9.6, and 11.2 for beneficiaries with mild, moderate, and severe HF, respectively; and 6.5,7.3, and 7.8 in the outpatient setting, respectively. For beneficiaries with mild disease, only 10% of all office visits were specifically for HF, while those with moderate or severe disease, only 20% were specifically for HF. Medicare beneficiaries with HF, even those with mild disease, have a large number of providers ordering and providing care. These data highlight the importance for developing systems and processes of coordinated care for this population.

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Abstract 2707: The Magnitude of Health Care Resource Utilization by Medicare Beneficiaries with Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_600-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Robert L Page ◽

Kara B Strongin ◽

Roger M Mills ◽

Christopher Hogan ◽

JoAnn Lindenfeld

Keyword(s):

Heart Failure ◽

Health Care ◽

The United States ◽

Hospital Inpatient ◽

Medicare Beneficiaries ◽

Data Set ◽

Physician Visits ◽

Hospital Outpatient ◽

Co Morbidity ◽

Medicare Spending

Introduction: By 2010, the number of individuals ≥ 65 years with a heart failure (HF) diagnosis should increase by an additional 700,000. As the financial burden of HF is expected to substantially increase, we examined health care expenditures of Medicare beneficiaries with HF to estimate the current healthcare costs and resource allocation. Methods: An analysis of 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. The cohort was defined by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model which requires one HF diagnosis from a physician or hospital outpatient department/inpatient bill. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. Results: Based on inclusion criteria, 260,076 beneficiaries were identified. Beneficiaries with HF accounted for 13% of the total beneficiary population and 37% of all Medicare spending. Reimbursement for hospital inpatient admissions, physician visits, and hospital outpatient visits accounted for $12,556; $5,875; and $2,753 per-capita, respectively. In one year, 22% of all beneficiaries required hospitalization compared to 59% of beneficiaries with HF. Thirty-one percent of beneficiaries with HF had ≥ 2 inpatient admissions. Twenty-four percent of all hospital discharges were for HF, either as a principal diagnosis or co-morbidity, accounting for $30.4 billion. On average, 8.3 different outpatient and inpatient providers ordered services for a single beneficiary. Beneficiaries with at least two prior HF hospitalizations within the index period had on average 3.04 physician visits every three months. Only 26% of these visits were conducted by a cardiologist. Conclusion : Medicare beneficiaries with HF impose a tremendous burden on Medicare, consisting of over one-third of Medicare spending. It will be important to determine how much of this burden is due to HF and how much to comorbid conditions. Development of specialized Medicare HF Management Programs, also providing comprehensive care for co-morbidities, could curtail these admissions and potentially reduce costs.

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Assessing Blood Administering Practices

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0595-abap ◽

1999 ◽

Vol 123 (7) ◽

pp. 595-598 ◽

Cited By ~ 1

Author(s):

Ira A. Shulman ◽

Sunita Saxena ◽

Lois Ramer

Keyword(s):

Health Care ◽

Los Angeles ◽

Los Angeles County ◽

Medical Center ◽

Health Care Financing ◽

Vital Signs ◽

Data Driven ◽

Blood Component ◽

University Of Southern California ◽

Health Care Financing Administration

Abstract The risk that a red blood cell unit will be associated with an ABO-incompatible transfusion is currently slightly greater than the aggregate risk of acquiring human immunodeficiency virus, human T-cell lymphotropic virus, hepatitis B virus, or hepatitis C virus by transfusion. Since the most common cause for ABO-incompatible transfusion is the failure of transfusionists to properly identify a patient or a blood component before a transfusion, transfusion services are encouraged to evaluate and monitor the processes of dispensing and administering blood. In addition, a proposal of the Health Care Financing Administration of the Department of Health and Human Services would require hospitals to use a data-driven quality assessment and performance improvement program that evaluates the dispensing and administering of blood and that ensures that each blood product and each intended recipient is positively identified before transfusion. The Los Angeles County+University of Southern California Medical Center assesses the blood dispensing and administering process as proposed by the Health Care Financing Administration. During the fourth quarter of 1997, 85 blood transfusions were assessed for compliance with the Los Angeles County+University of Southern California Medical Center policies and procedures: 55 transfusion episodes had no variance from institutional protocol and 30 had one or more variances. Of the transfusions with at least one variance, 16 had one or more variances involving the identification of the patient, the component, or the paperwork. The remaining 14 transfusions had one or more variances involving other criteria (nonidentification items). The most frequent variance was the failure to document vital signs during the first 15 minutes after a transfusion was started or after 50 mL of a component had been transfused. No variances in patient or blood component identification were noted in nursing units whose staff routinely performed self-assessment of blood administering practices. Based on these findings, a corrective action plan was implemented. Follow-up assessments (n = 63) were conducted after 3 months (during the second quarter of 1998). The compliance with the pretransfusion identification protocol improved from 81% to 95%. The most common reason for noncompliance continued to be a lack of checking vital signs. This report demonstrates the value of using a data-driven program that assesses blood administering practices.

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