Abstract 4364124: Reducing Medicare 30-day heart failure readmissions and saving dollars with an aggressive “ <i>4 Weeks 4 Meds</i> ” heart failure clinic

Abstract

Background: Medicare heart failure readmissions are costly. The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for high rates of Medicare 30-day heart failure (HF) readmissions. Decreasing HF readmissions is a fundamental goal of compassionate, cost-efficient heart failure care. Utilization of the four pillars of guideline-directed medical therapy (GDMT) can help reduce heart failure readmissions. Question: Does establishing an aggressive, GDMT-centric HF clinic decrease Medicare 30-day HF readmissions? Goals/Aims: Demonstrate the value of a physician-led HF clinic designed to reduce readmissions within a 285-bed hospital community. Demonstrate the value of 4 Weeks 4 Meds – a clinical algorithm predicated on aggressive initiation and uptitration of the four pillars of GDMT. Methods: From 2016 to 2024, Medicare 30-day HF readmissions data were tracked from Centerpoint Medical Center, a 285-bed hospital in Kansas City, Missouri. Annual HRRP penalties were tracked over this period. Beginning in 2022, a physician-led HF clinic consisting of one physician (0.5 FTE), two nurse practitioners (0.8 FTE total), one RN (0.8 FTE), and a dedicated HF-phone line was created. HF clinic utilized an early, aggressive guideline directed medication strategy in patients with reduced ejection fraction. Twice weekly multidisciplinary HF meetings were established with a dedicated inpatient HF RN Navigator (1.0 FTE) who maintained good standing with AHA-GWTG and GWTG-IMPLEMENT HF registries. Also included in these meetings: Inpatient pharmacy, cardiac rehab, case management, and hospital/clinic administration. Medicare 30-day readmissions data was then compared before and after the establishment of our community HF clinic. Results/Data: Between 2016 and 2024, Centerpoint medical center averaged 110 Medicare HF admissions per year. From 2016 to 2021, 18.4% of Medicare primary HF admissions were readmitted within 30 days. After establishing a HF clinic, from 2022 to 2024 Medicare 30-day HF readmissions decreased to 13.5% ( p 0.01) . Annual Medicare HRRP penalties decreased from the maximum 3.00% of Medicare revenue in 2019 to 0.17% in 2023, an annual penalty savings in excess of one million USD. Conclusion: In this example, a physician-led HF clinic reduced 30-day Medicare HF readmissions and helped lower costly HRRP penalties. Not shown in this economic data - the improved quality of life and patient years added with an aggressive community-based heart failure team.