Building the Business Case

Building the Business Case for Your Heart Failure Improvement Efforts

Assessing the financial impact of interventions to optimize HF care can include performance on specific core measures, readmission rates and creation of capacity for institutions that may have very high patient census.  It is important to demonstrate return on investment, to garner support for initiating more QI initiatives, and to showcase how improving quality is cost-effective. Your assessments of financial impact can be incorporated into slide shows and conversations with your administration. Your organization may be able to use data collected and improvements made to negotiate with payers and to market services.

Some payers may use specific performance thresholds on specific HF core measures (see core measure section ) in their calculation of a quality bonus or incentive for the organization.

To find out about whether any of these incentives exist within your organization involves a conversation with your CFO. This is best done in collaboration with your administrative champion.

Another important financial impact to measure is the current HF readmission rate. For Medicare patients discharged with heart failure who are readmitted with heart failure again within 8 days of discharge there may be gaps in reimbursement that could be explored. For other patients, the prevention of avoidable readmissions may free up bed capacity and improve appropriate utilization of resources and hospital throughput.

In order to understand the full financial impact of an intervention, it is important to take into consideration the potential number of admissions avoided and the number of hospital days saved or created for another patient. 

These financial analyses are examples of strategies to use to measure the financial impact of current performance and the potential both direct and indirect impact on future reimbursement and resource utilization.

As CMS expands its development of Pay for Performance opportunities, there may be other opportunities to link the improvement in heart failure care to reimbursement.  These include the recently launched PQRI (Physician Quality Reporting Incentive) which includes HF care measures.