Table 1.

Medicare FFS population metrics and sensitivity testing for treatment cost of worsening HF

Total Medicare FFS beneficiariesa	38,847,000
Total Medicare FFS spenda	$392,435,000,000
Medicare FFS HF population metrics	−10%	Baselineb	+10%
Prevalence of HF	9.5%	10.5%	11.6%
Rate of HF admissions per 1,000 HF patients	209.4	232.7	256.0
Rate of physician office visits for the treatment of worsening HF per 1,000 HF patients	8.3	9.3	10.2
Rate of ED visits for the treatment of worsening HF per 1,000 HF patients (not resulting in admission)	29.7	33.0	36.3
Rate of observation unit visits for worsening HF treatment per 1,000 HF patients (not resulting in admission)	16.1	17.9	19.7
Average cost per HF admission	$11,385	$12,650	$13,915
Average 30-day post-discharge cost following an HF admission (net 30-day baseline HF costs)	$5,393	$5,992	$6,591
Average cost per physician office visit for the treatment of worsening HF	$449	$499	$549
Average cost per ED visit for the treatment of worsening HF	$1,162	$1,291	$1,420
Average cost per observation unit visit for the treatment of worsening HF	$3,067	$3,407	$3,748
Medicare FFS worsening HF costs	−10%	Baseline	+10%
Total Medicare FFS treatment cost for hospital and OP treatment of worsening HF (in millions)	$9,299	$12,756	$16,978
Percentage of total Medicare FFS population spend	2.4%	3.3%	4.3%

Notes: All costs are presented in US$.

^a2017 Board of Trustees Report. Office of the Actuary.

^b2013–2014 Medicare 5% Sample analysis. 2014 costs have been trended to 2017 using a 2.2% annual trend factor.

Abbreviations: ED, emergency department; FFS, fee-for-service; HF, heart failure; OP, outpatient.