Abstract
In the USA, it is common for acute decompensated heart failure to present for emergency care, observational care, or inpatient care hospitalization for stabilization. Postdischarge, patients who diagnosed with acute heart failure are more likely to have increased morbidity and mortality. In an effort to decrease adverse outcomes, regulatory requirements are becoming more pervasive and include reimbursement coverage determination and performance management. This chapter provides details of coverage requirements for drug and cardiac device use and monitoring that may apply in acute heart failure care when patients are treated by an observation (outpatient) or hospital service and hospital performance management expectations that may affect reimbursement.
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References
Bernheim SM, Grady JN, Lin Z, et al. National patterns of risk-standardized mortality and readmission for acute myocardial infarction and heart failure. Update on publicly reported outcomes measures based on the 2010 release. Circ Cardiovasc Qual Outcomes. 2010;3: 459–67.
Heidenreich PA, Sahay A, Kapoor JR, Pham MX, Massie B. Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs health care system 2002 to 2006. J Am Coll Cardiol. 2010;56:362–8.
Bueno H, Ross JS, Wang Y, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA. 2010;303:2141–7.
Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics 2010 update: a report from the American Heart Association. Circulation. 2010;121:e45–e215.
Fonarow GC, Abraham WT, Albert NM, et al. Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Am J Cardiol. 2008;102(11):1524–9.
Fonarow GC, Abraham WT, Albert NM, OPTIMIZE-HF Investigators and Coordinators, et al. Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. J Am Coll Cardiol. 2008;52(3):190–9.
Albert NM, Yancy CW, Liang L, et al. Use of aldosterone antagonists in heart failure. JAMA. 2009;302(15):1658–65.
Shah B, Hernandez AF, Liang L, Get With The Guidelines Steering Committee, et al. Hospital variation and characteristics of implantable cardioverter-defibrillator use in patients with heart failure: data from the GWTG-HF (Get With The Guidelines-Heart Failure) registry. J Am Coll Cardiol. 2009;53(5):416–22.
Albert NM, Fonarow GC, Abraham WT, et al. Predictors of delivery of hospital-based heart failure patient education: a report from OPTIMIZE-HF. J Card Fail. 2007;13(3):189–98.
Fonarow GC, Abraham WT, Albert NM, OPTIMIZE-HF Investigators and Hospitals, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007;297(1):61–70.
O’Connor CM, Stough WG, Gallup DS, Hasselblad V, Gheorghiade M. Demographics, clinical characteristics, and outcomes of patients hospitalized for decompensated heart failure: observations from the IMPACT-HF registry. J Card Fail. 2005;11(3):200–5.
Fonarow GC, Albert NM, Curtis AB, et al. Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the registry to improve the use of evidence-based heart failure therapies in the outpatient setting (IMPROVE HF). Circulation. 2010; 122(6):585–96.
Walsh MN, Yancy CW, Albert NM, et al. Equitable improvement for women and men in the use of guideline-recommended therapies for heart failure: findings from IMPROVE HF. J Cardiac Fail. 2010;16:940–9.
Yancy CW, Fonarow GC, Albert NM, et al. Influence of patient age and sex on delivery of guideline-recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Am Heart J. 2009;157:754–762.e2.
Hernandez AF, Fonarow GC, Liang L, et al. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA. 2007; 298(13):1525–32.
Horwich TB, Hernandez AF, Liang L, Get With Guidelines Steering Committee and Hospitals, et al. Weekend hospital admission and discharge for heart failure: association with quality of care and clinical outcomes. Am Heart J. 2009;158(3):451–8.
Albert NM, Fonarow GC, Abraham WT, et al. Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med. 2009;122(4):366–73.
Lee DS, Stukel TA, Austin PC, et al. Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department. Circulation. 2010;122(18):1806–14.
Ferrante D, Varini S, Macchia A, GESICA Investigators, et al. Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up. J Am Coll Cardiol. 2010;56(5):372–8.
Medicare National Coverage Determinations Manual. https://www.cms.gov/manuals/downloads/ncd103c1_Part1.pdf. Accessed 8 Oct 2010.
Centers for Medicare and Medicaid Services. Medicare Approved Facilities/Trials/Registries. http://www.cms.gov/MedicareApprovedFacilitie/. Accessed 13 Dec 2010.
Rossi JS, Flaherty JD, Fonarow GC, et al. Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: a report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure). Eur J Heart Fail. 2008;10:1215–23.
Davies P, Taylor F, Beswick A, et al. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2010;7:CD007131.
Davidson PM, Cockburn J, Newton PJ, et al. Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients? Eur J Cardiovasc Prev Rehabil. 2010;17:393–402.
Davies EJ, Moxham T, Rees K, et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail. 2010;12:706–15.
Centers for Medicare and Medicaid services. Pub 100-04 Medicare Claims Processing. http://www.cms.gov/transmittals/downloads/R1875cp.pdf. Accessed 8 Oct 2010.
Centers for Medicare and Medicaid Services. http://www.cms.gov/hospitalqualityinits/01_overview.asp? Accessed 8 Oct 2010.
Hospital Consumer Assessment of Healthcare Providers and Systems Hospital Survey. http://www.hcahpsonline.org/home.aspx. Accessed 7 Dec 2010.
National Quality Forum. http://www.qualityforum.org/. Accessed 7 Dec 2010.
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Albert, N.M. (2012). Regulatory Requirements in Acute Heart Failure. In: Peacock, W. (eds) Short Stay Management of Acute Heart Failure. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-627-2_3
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DOI: https://doi.org/10.1007/978-1-61779-627-2_3
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