The American College of Cardiology wants to cut by 20% the current rate of hospital re-admissions for patients with heart failure by 2012, said Dr. Jack Lewin, the College’s CEO.
The ACC is motivated by both a desire to help patients and the opportunity to piggyback on what they predict will soon be a hot health care issue: cutting unneeded hospital readmissions. The 2010 U.S. budget introduced in late February cited hospital readmissions during the first 30 days after discharge as a multibillion dollar dead weight targeted for reduction through a combination of reimbursement incentives and penalties. Four of the six most common causes of readmissions are cardiologic: heart failure, acute myocardial infarction (MI), coronary artery bypass grafting, and percutaneous coronary interventions (PCI), Dr. Lewin said. The ACC’s initial target is heart failure, followed by acute MI.
With a bullseye drawn on hospital readmissions by the government, it’s clear the ACC wants to be ahead on this issue and lead the effort rather than wait and let bureaucrats do the job.
The culprit in heart failure patients is often a botched hand-off of patients from the hospital staff to community cardiologists and primary care physicians. Poor communication means patients don’t get on or stay on the medications they need as outpatients, and also results in redundant testing. Another step that might cut readmissions is keeping patients hospitalized the first time for an extra day or two until they’re completely stable. The ACC will also collect new data on what’s causing readmissions and what’s succeeding in stopping it through its National Cardiovascular Data Registry.
The ACC will recruit several other professional societies and their members in this “Hospital-to-Home” program, including hospitalists and nurses. Dr. Lewin cited the success of the recent program aimed at reducing door-to-balloon times for treating acute MI patients by PCI as a model for the new initiative. He estimated that perhaps $2 billion a year is now wasted on preventable hospital re-admissions out of the roughly $37 billion spent annually on heart failure treatment in the United States.
—Mitchel Zoler @mitchelzoler