Clinical InvestigationCongestive Heart FailureDo heart failure disease management programs make financial sense under a bundled payment system?
Section snippets
Decision model
We developed a decision analytic model to assess the cost-savings potential of DM programs. The decision tree is displayed in Figure 1. The hypothetical patient cohort in the model is representative of all patients admitted with a primary diagnosis of HF. This cohort is similar to those enrolled in the trials of DM programs and was selected to resemble a community-based HF population. The principal time horizon for the analysis (ie, 30 days after an index hospitalization) was selected to model
Costs and outcomes
From January 1, 2001, through December 31, 2004, a total of 1,363,977 Medicare beneficiaries had an index HF hospitalization. The median cost of inpatient care for those patients readmitted within 30 days of an index hospitalization was $9,923 per patient (25th-75th percentile, $6,599 to $18,976). The corresponding mean cost was $17,122 (95% CI $17,050 to $17,195). In the context of a baseline 30-day readmission rate of 22.9% and the median cost, 30-day inpatient care distributed across all
Discussion
Disease management programs are costly; and without sufficient financial incentives, such programs are implemented infrequently.18 Before our analysis, the extent to which bundled payments (as a new reimbursement strategy) could incentivize hospitals to bolster coordinated care through interventions such as DM programs was unknown. Our analysis suggests that current bundled payments may provide a positive financial incentive to providers who implement effective DM programs. By reducing
Acknowledgements
We thank Erin LoFrese for her editorial contributions to this manuscript and Melissa Greiner for data and analytic support. Neither Ms LoFrese nor Ms Greiner received compensation for their assistance, apart from her employment at the institution where the study was conducted.
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Javed Butler, MD, MPH, served as guest editor for this article.