Congestion is important in patients with HF. The discomfort of swollen legs, shortness of breath and impaired cognitive function, to name a few, precipitate hospitalizations. In fact, fluid retention and congestion are the most common causes of hospitalizations for patients with HF. Not only do these symptoms serve as powerful indicators of adverse prognosis, but they could potentially be equally important as a therapeutic marker.

Diuretics are the basis of management for patients with congestion. Most clinicians, however, would probably agree that diuretic use is based more on empirical judgement and subjective evaluation than objective, clinical evidence. Although several interventions might improve congestion, it often goes underdiagnosed.


Clinical guidelines
Current clinical guidelines for the prevention and treatment of HF include a comprehensive approach. This may include pharmacologic intervention, lifestyle recommendations, treatment of comorbidities, and device therapy during hospitalizations, as well as coordination of care at home or during palliative care.

Because of the substantial burden imposed on the U.S. healthcare system, payers, providers and other stakeholders must work together to develop better, objective, relevant approaches for HF patients and their treatment.

In the face of all of this, the most effective approach for improving care and reducing hospitalizations has been through penalties for lack of care and incentives for reporting quality information and HF-related measures.

In 2005 the Centers for Medicare and Medicaid Services (CMS) published their first set of core process measures, which was then updated in 2008. This allowed visitors to compare hospitals based on outcome measures (30-day readmissions and mortality rates), as well as several process measures.

The CMS’ Physician Quality Reporting System used incentive payments to encourage physicians and healthcare professionals to report HF-related measures, mainly centered around effective clinical care. In 2012 CMS introduced the Hospital Readmissions Reduction Program, where hospitals are financially penalized for excess readmissions. In the first year of the program, over 2,200 hospitals experienced total penalties of about $280 million in Medicare payments.

In the last few years, CMS has introduced several additional programs such as the Hospital Value-Based Purchasing Program, where hospitals receive payment for achievements or improvements; the Bundled Payments for Care Improvement program, aimed to financially incentivize improved quality and coordination of care at a lower cost to CMS; and the Medicare Shared Savings Program, which aims to achieve better health for individuals, improve population health and lower growth in expenditures.

More Industry Headlines