Proposed Cardiac Bundles and Heart Attack Readmission Risk Over 90-days

The recently proposed mandatory bundled payment program for heart attacks and bypass surgeries is the latest push by CMS to extend the “at risk” period from a 30-day to 90-day period. This paradigm shift from 30-day readmission focus to a 90-day at-risk period will require a strategic approach to control the cost that occur during a period in which costs have been on the rise. However, it is important to understand how the risk of readmission for each condition declines over the 90-day “at risk period” to allocate time and resources effectively.

Let’s take the heart attack recovery process as an example. First, consider that the average hospital length of stay (LOS) for a heart attack is approximately 5 days . Next, consider that the “target” SNF LOS of conveners and managed care groups is approximately 15 days. This leaves a 70-day period when the patient is “at-risk” while living outside of an institutional care setting.  However, the risk of readmission to hospital takes 13 days to decline by 50% after hospitalization for a heart attack according to a study in the British Medical Journal. See the above timeline for the risk of first readmissions to a hospital for a heart attack over a 90-day “at-risk” period .

 i. Steiner C Barrett M Weiss A. HCUP Projections: Acute Myocardial Infarction (AMI) and Acute Stroke 2004 to 2015. 2015. HCUP Projections
 ii. Dharmarajan, K., A. F. Hsieh, V. T. Kulkarni, Z. Lin, J. S. Ross, L. I. Horwitz, N. Kim, et al. 2015. “Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study.” BMJ : British Medical Journal 350 (1)

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