For CV programs, documentation issues can cause significant reimbursement shortfalls downstream. That was the case at Chandler Regional Medical Center (Chandler), whose CV program was experiencing a mismatch between actual patient acuity and the billing data.
With help from heartbase, Chandler improved documentation issues around heart failure (HF) and recouped a six-figure revenue over a six-month period.
Pilot Study Rationale: Skewed Documentation, Inaccurate Revenue
Transcatheter Aortic Valve Replacement (TAVR) procedures are not known as major drivers of revenue; profit margins are incredibly tight given the cost of the device. Even so, Chandler’s TAVR revenue was strikingly low for the number of procedures that they were performing.
With some digging, the Chandler team found that the vast majority of their TAVR procedures were coded as MS-DRG 267, reflecting a valve replacement without any major complications or comorbidities (MCC).
That was an immediate red flag to Kerry Webb, MBA, BSN, RN, who was a Sr. Data Analyst at Chandler Regional Medical Center at the time of the study. “Chandler serves a high-acuity patient population where heart failure is very prevalent,” she shares. “We knew that patient acuity was high, but somehow it wasn’t being represented through documentation.”
Had those patients’ HF been properly documented, the cases would instead be coded as MS-DRG 266. That code documents HF (acute or acute-on-chronic) as an MCC and is reimbursed roughly $10k more per procedure than MS-DRG 267.
“When you do upwards of 170 TAVR cases a year, that $10k difference really adds up to a significant amount of money,” shares Webb, MBA, BSN, RN.
| MS-DRG Code | Procedure | MCC | Approx. Reimbursement (2026) |
| 266 | Endovascular Cardiac Valve Procedures | With | $44,595 |
| 267 | Endovascular Cardiac Valve Procedures | Without | $34,643 |
Two Keys to Improving Documentation
With a team of 71 cardiologists, Chandler needed an easy-to-use solution to accurately capture HF for their TAVR patients. Two solutions held the key to success.
First, the data analysis and cardiology teams collaborated to develop a standardized Heart Failure Supplemental Documentation Form (Form). With simple checkboxes, the Form accurately documents HF type and acuity before every TAVR procedure. The Form is a permanent addition to the workflow for TAVR procedures, and the provided information is added to the patient’s chart.
Just as critically, the team began using heartbase’s hbRecon solution for TAVR procedures. hbRecon leverages robust clinical registry data for coding reconciliation, ensuring that accurate clinical data is represented in billing.
hbRecon compares the coding data with the TAVR patient data captured in the ACC/STS TVT Registry Database. While both coding and registry data are captured from the EHR, they have different definitional requirements. By identifying mismatches between these two sources, hbRecon can flag cases where HF may have been present but not properly documented.
hbRecon serves as a critical safety net, assisting with appropriately documenting patient acuity and accurately capturing revenue. For Chandler, hbRecon delivered promising results quickly.
Improved Clinical Outcomes: Significantly Improved O/E Ratio
Chandler saw significant clinical improvements after implementing heartbase for TAVR procedures. Accurately capturing HF enabled Chandler to gain a clearer understanding of preprocedural risk for their patients—and the results were noticeable almost immediately.
“For TAVR procedures, our O/E ratio for 30-day mortality historically sat around 1.2,” explains Webb, MBA, BSN, RN. Ideally, that number should hover around 1.0. “We were on the high side because our documentation didn’t accurately reflect how sick our patients were. In just three weeks, heartbase had a profound impact.”
Within three weeks of the pilot study’s kickoff, heartbase helped lower Chandler’s O/E ratio to 1.16. That number improved to 1.01 after just three months of using heartbase, bringing Chandler in line with the industry standard.
“Our new O/E ratio more appropriately reflects the acuity of our TAVR patient population, and demonstrates the excellent care we’re able to provide,” shares Webb, MBA, BSN, RN.
| 30-Day Mortality O/E Ratio for TAVR Procedures | |
| Before heartbase | 1.21 |
| 3 Weeks With heartbase | 1.16 |
| 3 Months With heartbase | 1.01 |
Improved Financial Outcomes: Six Figures Recouped in Six Months
By ensuring that patient acuity was properly represented with MS-DRG 266, heartbase helped Chandler recoup a significant amount of revenue for their TAVR procedures. Within six months of the pilot study, heartbase helped Chandler secure an additional $370,000 in revenue.
“The reason heartbase allows us to capture more accurate revenue is that it assists us in educating our clinicians,” shares Webb, MBA, BSN, RN. “We’re educating them on what ‘acute’ means for heart failure, and why it matters. Heartbase gives them an easier way to document their patient’s diagnosis so that we’re reimbursed appropriately.”
The success with heartbase set the stage for the Chandler team to hit future revenue goals.
“Our cath lab was facing a 100-day workout to produce an additional $500,000 in revenue,” explains Webb, MBA, BSN, RN. “Once our cath lab director heard that our pilot with heartbase recouped nearly ¾ of that amount, she was excited to implement heartbase across other procedures.”
The promising outcomes with TAVR procedures led Chandler to quickly adopt the same heartbase process for their entire TVT program. Today, the hospital uses heartbase to promote clinical and financial accuracy for every TAVR, M-TEER, T-TEER, TMVR, and TTVR procedure.
Unlock Stronger Clinical and Financial Outcomes With Heartbase
Heartbase is the first solution of its kind to leverage CV data and account for MCC capture, improving both clinical and financial outcomes for procedures such as TAVR. See the full Chandler pilot study for more details on their success with heartbase, or schedule a demo to see how hbRecon can support your own CV program.