The Affordable Care Act is pushing hospital’s to come up with an effective, coordinated effort to reduce heart failure readmissions or else face a costly penalty starting in October 2012.
Hospitals across the country are faced with the challenge of creating programs that employ coordinated, multidisciplinary care, patient education, and effective utilization of healthcare resources to address heart failure readmissions.
The process began when Medicare reviewed 235 diagnoses and found that heart failure was number one in hospital readmissions. The review found that 20% of heart failure patients are readmitted to the hospital within 30 days. And, in fact, 50% of the Medicare deficit is spent on heart failure care.
To begin addressing this issue, Jewish Hospital and Sts. Mary & Elizabeth Hospital, both a part of KentuckyOne Health, began a pilot program called HeartCheck in partnership with VNA Nazareth Home Care in June 2011.
HeartCheck is a complete, interdisciplinary approach to heart failure management that employs skilled nurses, dietitians, physical, occupational, and speech therapists, pharmacists, and social workers under the direction of physicians with advanced training in heart failure.
Through the program, VNA providers and physicians collaborate to teach patients the appropriate tools for the self-management of heart failure. It also provides support for patients in the environment where they face their daily challenges – at home and in the work place.
There are approximately six million people living in the United States with heart failure. About 60% of those patients can be safely managed in the outpatient setting through programs like HeartCheck, which provides frequent follow up and reinforcement of the tools being used to manage the disease in the acute care setting.
In 2010 and 2011, Jewish Hospital and Sts. Mary & Elizabeth Hospital had 2,700 discharges with heart failure diagnoses and a readmission rate of 25%, which is similar to many acute care hospitals in the nation. Patients in the HeartCheck pilot had a 3.5% readmission rate — a 21.5% reduction.
HeartCheck’s uniqueness is not only centered around its affiliation with a heart failure and transplant center that performs 15 to 18 transplants per year and upwards of 70 LVADs, but it is also the first coordinated effort to treat patients with heart failure that is guideline-driven and employs “best practices” from the Heart Failure Society of America and American Heart Association, while emphasizing the patient’s role in managing the disease process.
VNA providers are experienced with evaluating and treating heart failure patients. More than 200 VNA nurses have been trained through HeartCheck to assess fluid volumes and administer IV diuretics in the home. They are also trained in recognizing heart failure medical emergencies.
Instead of heading to the emergency room, HeartCheck patients are instructed to contact their VNA liaison who can triage the necessary next steps, often eliminating the need for an emergency room visit. The liaison communicates with the primary care provider and heart failure physician to determine a course of treatment. Often the VNA liaison can administer IV diuretics in the home, and the patient can be seen for follow up at the outpatient care clinic at either Jewish Hospital or Sts. Mary & Elizabeth Hospital.
Crisis intervention can also occur in the outpatient setting. HeartCheck patients can receive IV diuretics for eight hours at the outpatient care clinic. During their care, there is ample time for patient education, which includes everything from a dietitian providing a lesson about salt intake to other critical tips for managing the disease. Following care at an outpatient care clinic, patients receive a follow up visit from their VNA care provider within two or three days.
With HeartCheck, a patient’s primary care provider remains an active part in the management and care of the patient. They review and sign off on order sets and receive regular updates and notifications of any intervention from the VNA liaison. The program also provides primary care providers with the opportunity for their patient to arrange follow up care in their office or at a heart failure outpatient care center.
VNA hopes HeartCheck will become a model for hospitals across the country working to reduce heart failure readmissions. Currently 70 patients are enrolled in the program. The patients are educated and empowered to manage their disease process.
The early success of HeartCheck is very promising and the program has the capacity to handle more than 200 patients at once.
Individuals at high risk for readmission who may be candidates for HeartCheck are New York Heart Association Class III heart failure patients who are admitted to the hospital on average twice a year, have a prolonged hospital stay, or are identified by discharge planner or primary care provider.
Primary care and other physicians can refer a patient to the HeartCheck program by calling (502) 585-7699 or simply writing an order for the VNA HeartCheck program.