I knew an elderly man who suffered from heart failure. Every few years, he would get to the point where he couldn’t walk very far, his feet swelled, and he had repeated hospitalizations to get stabilized and get his medication in line. Then, the hospitalizations would stop. He managed reasonably well for some years until he was near the end of his life, when he had lung complications. It wasn’t clear what came first: the lung compromise or the heart failure. He declined rapidly. A friend’s mother has had heart failure for years. She recently started oxygen and is in a hospice program. She hasn’t been in the hospital at all within the past year, and considering everything, she is doing quite well. Yet other older Americans find themselves on a rollercoaster: going in and out of hospitals and not quite understanding their medication regimen, limitations on diet, and the benefits of exercise.
The Centers for Medicare and Medicaid (CMS) has been pushing hard to reduce “potentially unnecessary” and high-cost hospital readmissions for heart failure. More than any other condition, heart failure is the leading cause for readmission. It turns out that, on average, about 1 in 5 people with heart failure will be readmitted within 30 days. A Medicare Payment Advisory Committee survey revealed that Medicare readmissions for all causes total $17 billion.
One target that has been talked about is bringing the heart failure readmission rate down to 1 in 10.
CMS has hospitals scrambling to get these numbers down and nurse-led programs are working to assure better preparation for discharge and self management. The threat of Medicare penalties is looming. Potentially avoidable readmissions for heart attacks, pneumonia, and infections are also under scrutiny.
Hospital Data Viewable on the Web
Some health policymakers consider data on hospital outcomes and patient satisfaction as a potential driver for change. Already, journalists have picked up the ball, reporting hospitals with higher than average hospital readmissions for heart failure, pneumonia, and infections, and data-hungry public can examine the data now available at the Centers for Medicaid and Medicaid Services MedicareHospitalCompare. Many people think that the public will vote with their feet and take their health care elsewhere if they see high readmission rates or death rates out of whack at their hospitals. It is certainly a consideration, but I wonder whether people in search of care for a chronic condition might pay more attention to outcomes by physicians in their area, if they can find them anywhere. They might pick their doctor, regardless of hospital affiliation.
I spent some time with MedicareHospitalCompare yesterday, looking at hospitals in my own community. I wish that CMS had a quick-start tutorial on how to use it. I think only data-oriented patients will go through the steps to see how hospitals do in their area. There are limitations with the dataset. You can only compare three hospitals at a time. Some hospitals have data footnoted as problematic, meaning that you don’t know whether to trust it at all. Also, I saw one hospital listed that combined two independent sites that really don’t talk to each other. I flagged one hospital out of six that had a higher than average heart failure readmission rate. I wondered about that and may consider looking for doctors not affiliated with that particular hospital.
Heart Failure Self Management
Policymakers hope that patients with heart failure can be educated to better self-manage their disease. It is certainly an admirable goal. Indeed, around the country, panoply of interventions are being tried, including transitional care, hospital-to-home programs, and cognitive training on medication and weight management. Numerous other strategies are being evaluated, including remote monitoring and telephone consultation. Nurses are doing yeoman work to smooth out the care and their efforts should be applauded. I’ll discuss some of this work in a subsequent post in the next week.
I’d like to hear from readers on what you think would help patients and caregivers. Do you or has someone close to you suffered from heart failure? How are they managing? What has helped them? Is there information that you would like to see made available that would help you pick a doctor or facility that provides high-quality care? Have you participated in any programs that have helped you or your family manage heart failure and stay out of the hospital?
NEXT: SOME OF THE RESEARCH ON LEARNING TO MANAGE HEART FAILURE AND RECOMMENDED BOOKS AND WEBSITES.
I wonder if heart disease doesn’t inherently set you up for confusion – self-management counterindicated…
One big lifesaver from my experience around congestive heart failure is to be cognizant of EARLY signs of fluid retention which, when caught soon enough, may simply involve a phone call to patient’s cardiologist allowing doctor to prescribe extra diuretics for time being. Relatives and friends AND patient can be educated regarding signs/symptoms. Some of these include increased shortness of breath and/or fluid accumulation (edema) in ankles. These must be addressed immediately as time is of the essence in avoiding yet another hospital visit.