Heart Failure Solutions
Why HFS

A program built to pay for itself and reduce penalty exposure.

The financial case looks different for a health system than for an independent practice. Here is each one, and how we track whether it is working.

Health systems

The penalty-avoidance case

Medicare's Hospital Readmissions Reduction Program penalizes health systems for excess 30-day heart failure readmissions.

  • Objective hemodynamic data in place of symptom reports
  • A defined escalation pathway for out-of-range readings
  • Decompensation caught before it becomes a readmission
Independent practices

The under-capture case

Many practices already do this work informally. They just do not document or bill it correctly.

  • Patients with implanted sensors create a recurring monthly remote-monitoring billing opportunity
  • TCM 7- and 14-day follow-up codes pay more than a standard office visit
  • Both are routinely under-captured
How we measure it

Five numbers, reviewed every month.

Each engagement includes a monthly scorecard reviewed by your program steering committee. The goal is to catch gaps in weeks, not a year later.

Metric 1

Readmission rate

Are fewer heart failure patients coming back within 30 days?

Metric 2

TCM capture rate

Is the follow-up work being documented and billed as TCM?

Metric 3

Monitoring-billing capture rate

Is remote monitoring being billed each month it is provided?

Metric 4

Escalation-response compliance

Are out-of-range readings being acted on within the defined window?

Metric 5 · Overall

Inpatient heart failure population

Is the overall inpatient heart failure population falling as care shifts primarily to the outpatient setting?

Actual results vary by organization. Heart Failure Solutions provides workflow, training and coding-education consulting. It does not guarantee financial or clinical outcomes and does not submit claims for clients.

Clinical evidence

What the published data show.

Each pillar rests on published studies, and the evidence is stronger for some than for others. Every entry below names the study design next to the result.

Pillar 01

Hemodynamic monitoring

Limits of the evidence. The randomized trials are of CardioMEMS. Cordella was tested without a control group, and the ZOLL HFMS trial was not randomized.

  • CardioMEMS · CHAMPION · Randomized trial, 550 patients
    Pressure-guided management reduced heart failure hospitalizations by 33% over the full randomized follow-up, which averaged 18 months.
    Abraham WT, et al. Lancet. 2016;387:453–61.
  • CardioMEMS · CHAMPION, patients aged 65 and older · Retrospective analysis
    Among Medicare-eligible patients, all-cause readmissions within 30 days were 58% lower with pressure-guided management.
    Adamson PB, et al. Circ Heart Fail. 2016;9(6).
  • CardioMEMS · MONITOR-HF · Randomized trial, 348 patients
    Heart failure hospitalizations and urgent visits fell by 44% (hazard ratio 0.56; 95% CI 0.38 to 0.84), and quality-of-life scores improved by 7 points at 12 months.
    Brugts JJ, et al. Lancet. 2023;401:2113–23.
  • CardioMEMS · GUIDE-HF · Randomized trial, 1,000 patients
    The trial did not meet its primary endpoint overall (hazard ratio 0.88; p = 0.16). An analysis limited to the months before COVID-19 showed a 19% reduction in deaths and heart failure events (hazard ratio 0.81; p = 0.049).
    Lindenfeld J, et al. Lancet. 2021;398:991–1001.
  • Cordella · PROACTIVE-HF · Single-arm trial, 456 patients
    The 6-month rate of heart failure hospitalization or death was 0.15 events per patient, against a pre-set performance goal of 0.43 (p < 0.0001). The trial had no control group.
    Guichard JL, et al. JACC Heart Fail. 2024.
  • ZOLL HFMS · BMAD · Non-randomized controlled trial, 494 patients
    When clinicians received the sensor data, heart failure rehospitalization within 90 days of discharge was 38% lower (hazard ratio 0.62; p = 0.03), an absolute reduction of 7 percentage points.
    Boehmer JP, et al. JACC Heart Fail. 2024;12:2011–22.
Pillar 02

Transitional care and early follow-up

Limits of the evidence. These are observational studies. No randomized trial has tested the TCM billing codes in heart failure specifically.

  • Early follow-up · Observational, 30,136 Medicare patients at 225 hospitals
    Hospitals that saw the fewest heart failure patients within 7 days of discharge had a 30-day readmission rate of 23.3%. Hospitals with higher early follow-up had rates of 20.5% to 20.9%.
    Hernandez AF, et al. JAMA. 2010;303:1716–22.
  • TCM visits · Observational, 3,762 matched patients
    Patients whose follow-up was a TCM visit had a 30-day readmission rate of 8.4%, against 13.9% for matched patients with a standard follow-up visit (p < 0.001). The study covered general medicine discharges, not heart failure alone.
    Kim EJ, et al. PLoS One. 2025;20(1):e0316892.
  • TCM services · Observational, Medicare claims 2013 to 2015
    TCM was followed by lower mortality (1.0% vs 1.6%) and lower Medicare costs ($3,033 vs $3,358) in days 31 to 60 after discharge. It was billed for only 7% of eligible discharges in 2015.
    Bindman AB, Cox DF. JAMA Intern Med. 2018;178(9):1165–71.
  • Transitional care programs · Systematic review, AHRQ
    Follow-up in a multidisciplinary heart failure clinic and home-visiting programs each reduced all-cause readmission over 3 to 6 months, with high strength of evidence.
    Feltner C, et al. AHRQ Comparative Effectiveness Review No. 133. 2014.
Pillar 03

Rescue diuretics

Limits of the evidence. No completed randomized trial has yet shown that either product reduces hospitalizations or 30-day readmissions. The case so far rests on cost, symptom and absorption data.

  • Furoscix · FREEDOM-HF · Matched historical controls, 24 and 66 patients
    Patients sent home from the emergency department on subcutaneous furosemide had 30-day heart failure costs $16,995 lower per patient than matched patients admitted for under 72 hours (p < 0.001). One of the 24 was hospitalized within 30 days.
    Bensimhon D, et al. Future Cardiol. 2023;19:385–96.
  • Furoscix · AT HOME-HF · Pilot randomized trial, 51 patients
    The primary 30-day composite of cardiovascular death, heart failure events and NT-proBNP change did not differ significantly from usual care (win ratio 1.11; 95% CI 0.48 to 2.50). Breathlessness and 6-minute walk distance improved more with subcutaneous furosemide.
    Konstam MA, et al. JACC Heart Fail. 2024.
  • Enbumyst · Pharmacokinetic study, 68 healthy adults
    FDA approval in September 2025 rested on a crossover study in which the nasal spray met equivalence to oral bumetanide. No study has yet reported its effect on hospitalizations or readmissions.
    Corstasis Therapeutics. FDA approval announcement, September 15, 2025.

Summary prepared October 2026 for healthcare professionals. It is not medical advice. Study results describe the populations studied and do not predict results for any organization or patient.

Find out which case applies to your organization.

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