Aligning quality and payment for heart failure care: defining the challenges

J Card Fail. 2003 Aug;9(4):251-4. doi: 10.1054/jcaf.2003.30.


Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues. A conflict between the highest quality of care and financial solvency does not serve the interests of patients, physicians, hospitals, or payers. In principle, resolution of this conflict is simple: reimbursement systems should reward higher quality care. In practice, resolving the conflict is not simple. A recent roundtable discussion sponsored by the Heart Failure Society of America identified 4 major challenges to the design and implementation of reimbursement schemes that promote higher quality care for heart failure: defining quality, accounting for differences in disease severity, crafting novel payment mechanisms, and overcoming professional parochialism. This article describes each of these challenges in turn.

Publication types

  • Review

MeSH terms

  • Delivery of Health Care / economics
  • Heart Failure / economics*
  • Heart Failure / therapy*
  • Humans
  • Insurance, Health, Reimbursement / economics*
  • Quality of Health Care / economics*
  • United States