The Heart Failure Clinic

1. The Heart FailureClinic Cindi Hayes, ARNP Donna Winsor-Dorough, ARNP September 2008

3. Problem Overview - National Heart Failure affects 5 million in the U.S. with 550,000 new diagnoses each year and contributes to about 300,000 deaths per year. Heart Failure is one of the leading causes of hospitalizations with readmission rates up to 50% at 6 months. NHDR reports that racial, ethnic and socioeconomic disparities are a pervasive national problem affecting all levels of healthcare. Higher rates of avoidable admissions occur among those of lower socioeconomic position. We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

4. Problem Overview - Local Florida Hospital will serve 2,730 CHF patients by the end of 2005. Of these, 264 patients are Medicaid or Self Pay, representing 9.6% of the total CHF patients treated at FH. The average LOS is 4.99 days. In 2004, FH experienced an N.I. loss of $(1.75M) on CHF cases. Avg. loss per Self Pay case - $(4,712) Avg. loss per Medicaid case - $(629) Avg. loss per Medicare case - $(950) We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

5. Cost and Utilization The current readmission rate for Medicaid and Self Pay CHF patients was 39.4%, representing a loss of $(350K) per year. These readmits account for 519 unnecessary patient days each year. We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

6. Root Cause Analysis Leading causes of heart failure: Ischemic heart disease Hypertension Diabetes Arrythmias Idiopathic/viral Valvular disease We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

7. Root Cause Analysis Burden of heart failure for the individual: Diminished quality of life Diminished productivity Social isolation Increased financial burden We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

8. Causes of Hospital Readmissions for Heart Failure We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

9. The Intervention: Overview The Heart Failure clinic established to provide free comprehensive heart failure disease management to high risk patient populations. Heart failure management in the clinic is provided by nurse practitioners in collaboration with a cardiologist medical director. The initial target population was the Self Pay and Medicaid patients with plans for expanding to the Medicare population. We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

10. The Intervention: Overview There was no access to focused heart failure care in the community for this targeted population. This initiative proposed to produce positive clinical outcomes by evaluating and treating reversible causes of heart failure utilizing national guidelines. Objectives to be met through optimization of pharmacologic regimes and disease management counseling. Quality of life to be improved through the efforts of this program. We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

11. Measurable Impacts & Evaluation Target Measures: Readmission rate at or below 10% Length of Stay reduced by 1 day by payer class Quality of Life measures including NYHC Minnesota - Living with Heart Failure Mortality Review data on a monthly bases to track our achievable goals and make any necessary programmatic adjustments. We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

12. Heart Failure Clinic Clinic Opened in March 2006 for patients without insurance Medicaid patients accepted 186 Total Patients seen at the Clinic Over 3000 patient visits We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

13. Readmission Rates We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

14. Ejection Fraction

15. Minnesota-Living with Heart Failure

16. VR NOT USED. Figure 3 stacked bar graph used instead.VR NOT USED. Figure 3 stacked bar graph used instead.

17. Quality Care in the right setting = reduced cost &improved outcomes History Avg. loss per Self Pay case - $(4,712) Avg. loss per Medicaid case - $(629) Avg. loss per Medicare case - $(950) The care for 1 patient in the Heart Failure Clinic for 1 year is less than half the cost of 1 hospital admission Keys: access to care, extensive education, removing barriers, community resources We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

18. Lessons Learned Identify Core Business Impact to Help Justify Program Investment Look for External Support Opportunities: Grants: CHIC2, Chatlos Partnerships: Orange County, P-CAN Clinics, Shepard�s Hope Wal-Mart Pharmaceuticals We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.

19. Questions & Comments

20. 2006 -2007 Savings for Medicaide& Self Pay

21. Medicaid & Self Pay Trend

22. Heart Failure Clinic Budget Performance We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.We should attempt to have at least some preliminary discussion about root causes, as this Due to time, we probably won�t be able even to touch the Assets item during this meeting.