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Addressing the 100% of heart failure: a call for complete care of all ages.

During the past several years, the nation’s health systems and providers have frantically put into place programs to reduce readmission rates for heart failure (HF) and other conditions. Through public reporting or pay for performance initiatives focused on readmissions, hospital administrators now focus on care beyond the hospital doors. The basis for improving readmission rates largely rests on Medicare data showing wide variation and attributable costs of early readmissions among elderly Americans. Given that this population is the highest payer of the nation’s $1.6 trillion in hospital bills,1 the rationale to focus on Medicare beneficiaries is understandable. Certainly, Medicare must focus on resource-intensive conditions with poor outcomes like HF. Historically, other payers like Medicaid have had other areas in which to focus quality improvement efforts. With a predominantly younger population, maternal and neonatal stays account for 50% of all hospitalizations;2 however, the state of affairs may soon change for Medicaid plans. In 2014, states may opt to expand Medicaid as part of the Affordable Care Act—a landmark legislation that promises to expand coverage across the spectrum of health and disease. As a result, it is important to understand the impact of a condition like HF, which has high morbidity and mortality, on Medicaid programs. Furthermore, we must begin to define what may drive inefficiencies or poor quality of care for this population.

Article see p 672 

In this issue of Circulation: Heart Failure , Allen et al help us to understand the other 20% to 30% of HF that is unrepresented by previous studies profiling Medicare beneficiaries.3 Using administrative data from …