A cost-saving strategy for inpatient management of advanced decompensated heart failure patients: the Cardiomyopathy Unit.

BACKGROUND

This article analyzes the relative costs and revenues of the Tufts Medical Center Cardiomyopathy Unit (CMU), a recent innovation for grouping and managing advanced decompensated heart failure patients.

METHODS AND RESULTS

We selected a retrospective sample of all patients with the primary diagnosis of heart failure, primary procedure of pulmonary artery catheterization, and with no other hospitalization procedures, admitted to Tufts Medical Center between 2000 and 2006. Regression models were used to estimate the cost for the intervention group and controls. Propensity analysis was used to test for selection bias in the comparison groups. We identified 114 hospitalizations meeting these criteria. Patients in the CMU group were well-balanced compared with controls with respect to demographic and clinical variables. Estimated direct medical costs for CMU and control groups were $11,817 (95% CI $7678-$16,106) and $17,236 (95% CI $11,199-$23,493), respectively. A similar pattern of cost differentials was displayed among propensity-matched sample groups. Net revenue was $12,609 (95% CI $9578-$16,845) and $15,627 (95% CI $11,871-$20,877) in the CMU and control groups, respectively.

CONCLUSIONS

The inpatient CMU may offer a lower cost and higher contribution margin alternative for the management of advanced heart failure patients requiring hemodynamic monitoring without other major inpatient procedures.