F2 Solutions' algorithms help payers reduce the number of inappropriate admissions and improve the cost-effective utilization of tests, thus improving patient care at lower cost.

In spite of recently published guidelines, the evaluation and treatment of patients with a Faint or Fall is often haphazard and un-stratified. The result is inappropriate use of diagnostic tests, a high rate of misdiagnosis, and a significant number of unwarranted hospital admissions and tests. With an estimated yearly cost of $440 million to the State of Utah, adopting F2 Solutions' algorithms should yield significant savings.

The Cost of Faint

In 2005, faint related hospital costs have been estimated to be $2.4 billion, with a mean cost of $5,400 per hospitalization. In a recent study conducted at the University of Utah, the overall estimated prevalence rate of faint was 9.5 patients per 1000 inhabitants and increased progressively with age reaching the values of 28 per 1000 inhabitants in subjects aged 70-79 years, and 40 per 1000 inhabitants in subjects aged >80 years. About two-thirds of the evaluation for faint occurred in the outpatient setting and 18% of patients sought medical attention in the Emergency Department. Ten percent of patients presenting with faint were admitted to inpatient service. The mean payment was $2,517 and the average cost per hospital admission was $12,640. The estimated total yearly payments per 1 million-population were $33,224,400. For the overall population of the state of Utah, the total yearly payments were estimated to be $90,901,958.

Test Utilization

In a recent study including 100 patients presenting with Faint, there was underutilization of orthostatic testing (p=0.001), carotid sinus massage (p=0.001), and implantable loop recorders (p=0.07). Orthostatic testing was performed in only 24% of the cases and none of the patients had carotid sinus massage despite 26% of them being >65 years old. On the other hand, there was overutilization of imaging studies (p=0.001 for both echocardiogram and CT/MRI scan) and neurologic consultation (p=0.001). A high discrepancy of indications (“k” value <60%) was observed for admission, diagnosis at initial evaluation, neurological consultations and all tests except for coronary angiography. In another study involving 254 patients who presented to the Emergency Department with Faint, the number of inappropriate admissions and discharges were 69 out of 118 (58%) and 8 out of 136 (6%) respectively. The prevalence of serious events (SE) in the inappropriately admitted group (n=69) was not significantly different than in the appropriately discharged group (n=128)(3% versus 3%, p=NS). Similarly, the prevalence of SE in the inappropriately discharged group (n=8) was not significantly different than in the appropriately admitted group (n=49)(13% versus 16%, p=NS). F2 Solutions provides Payers with the tools needed to enhance their decision-making as they determine the short-term risk and need for admission when patients present to the ED with a Faint. In the outpatient setting, F2 Solutions provides Payers with a reference to assess whether the tests ordered in the management of patients with Faint were cost-effective and in adherence with the most recent published guidelines.

The Cost of Falls

Similar to Faint, Falls in older people are common and their impact can be devastating, causing significant morbidity and mortality. It is an important public health concern due to the amount of hospitalizations, deterioration, premature nursing home admissions, and the great expenditure to healthcare and social services. It has been estimated that the annual direct and indirect cost of Fall injuries will reach $54.9 billion dollars by 2020 without adjusting for inflation. In a recent study conducted by the University of Utah, the overall prevalence of Falls was 29.8 per 1000 inhabitants respectively, progressively increasing with age reaching the values of 70 per 1000 inhabitants in subjects aged 70-79 years, and 115 per 1000 inhabitants in subjects aged >80 years. The mean payment was $3,200 for fall. The average cost per hospital admission was $19,194. The estimated total yearly payments per 1 million-population for the Fall problem were $128,640,000, respectively. For the overall population of the state of Utah, the total yearly payments were estimated to be $351,959,040.

Recurrence of Fall Visits

Several studies have shown that most patients with Fall do not undergo a comprehensive evaluation resulting in under-evaluation of potential causes and a higher recurrence rate. Assessment followed by specific interventions has been shown to produce a significant benefit to patients. Therefore, a systematic framework is needed for the evaluation of the risks in each individual and to appropriately target the interventions. F2 Solutions provides Payers with a reference to assess whether the tests ordered in the management of patients with Fall were cost-effective and in adherence with the most recent guidelines. By ensuring that the proper tests are ordered, the diagnostic yield should increase and the recurrence rate should decrease resulting in better patient care at lower cost.

F2 Solutions Incremental Value to Payers

1. A reduction in the number of inappropriate admissions which have been shown to account for 1/3 to 1/2 of the current Faint admissions

2. An increase in the yield to diagnosis in patients with Faint or Fall thus reducing the recurrence rate and associated cost