Marked variation between hospitals in the rates readmission early after HF hospitalization and the belief that early readmissions after HF hospitalization may signal inadequate inpatient or transitional care has led many payers to target readmission rates (particularly those at 30-days) as a hospital performance metric.. It is envisaged that strategies targeted at readmission reduction might simultaneously improve both the quality and cost of care.

In 2009 the Centers for Medicare and Medicaid Services (CMS) began public reporting of all-cause readmission rates for a number of conditions, including HF, and in 2010 with the passage of the Patient Protection and Affordable Care Act, CMS were instituted financial penalties  for hospitals with worse-than-expected 30-day readmission rates for HF, myocardial infarction, and pneumonia. Since penalties are applied against total hospital reimbursement, the financial consequences for excessive rates of 30-day readmission are substantial.  At our hospital, for example, nearly $15–20 million of Medicare dollars were at risk between the years 2012 and 2015.  These data, coupled with the negative prognostic implications of recurrent hospitalization for HF patients, underscore the financial and clinical imperative for physicians to focus attention on prevention of heart failure readmissions.