Maximizing reimbursement in heart failure

By Avery Calhoun, fourth-year medical student, Medical College of Georgia, Augusta, Ga., avcalhoun@augusta.edu; Alexandra Poch, fourth-year medical student, Medical College of Georgia, Augusta, Ga., apoch@augusta.edu; and Janis Coffin, DO, FAAFP, FACMPE, MGMA member, chief transformation officer, Augusta University Health, Augusta, Ga., jcoffin@augusta.edu.

Heart failure (HF) affects an estimated 6.2 million Americans and is predicted to increase in prevalence by 46% by 2030.1 The estimated cost for HF management in 2012 was $30.7 billion and is predicted to rise to $69.8 billion by 2030, an estimated 127% increase.2 The most recent data states that HF accounts for roughly 900,000 hospital admissions (with HF as the primary diagnosis), 481,000 emergency department visits and 2.671 million outpatient visits annually.3 With the Center for Medicare & Medicaid Services’ (CMS) implementation of the Bundled Payments for Care Improvement (BPCI) initiative in 2013 and the advanced initiative in 2018, payment models for HF are changing. Given the prevalence and economic burden of HF, it is becoming increasingly important that providers understand how they will be reimbursed for their involvement in the care of patients with HF.