Benefits & Challenges of Outpatient UF Therapy

By Laura Serrano  /  July 7, 2022

Renowned Heart Failure Clinicians Discuss the Benefits and Challenges of Outpatient Ultrafiltration Therapy

On June 21, 2022, Nuwellis hosted a webinar discussion about using outpatient ultrafiltration therapy to break the cycle of heart failure readmissions. We were joined by three world-renowned heart failure (HF) clinicians who work with patients experiencing fluid overload challenges every day. Dr. Detlef Wencker, Dr. Ramesh Emani, and Mr. Patrick Correlli, PA, shared their experiences using Aquadex therapy and discussed the current clinical landscape, including the patient experience and the reimbursement picture.

You can watch the full 1-hour webinar discussion here.
You can also watch this short recap video to get the highlights in under three minutes.

Below we’ll discuss some of the key discussion points and takeaways from the webinar.

The problem: HF Patients with Fluid Overload Face a Costly Cycle of Hospital Readmissions

 The current standard of care for managing fluid overload among HF patients is clinically and economically challenging for patients and hospitals. The vast majority of HF patients with signs of fluid overload are hospitalized and endure long, costly inpatient stays. When they are discharged, patients typically will have unresolved congestion issues that can lead to readmission.

  • Roughly 25% of patients are readmitted within 30 days
  • Roughly 50% of patients are readmitted within 90 days

Dr. Emani spoke to the need to fully treat a patient’s congestion issues, and how that is more effective in an outpatient setting. Current outpatient strategies center on IV diuretics, but better solutions are needed to break the readmission cycle and bring down costs. Outpatient ultrafiltration with Aquadex therapy offers a viable alternative.

Dr. Wencker noted that ultrafiltration removes a significantly higher amount of sodium compared with hypotonic urine produced by diuretics. Mr. Correlli added that outpatient ultrafiltration helps to stabilize patients without the costs of inpatient care. He believes this is a paradigm shift in how doctors can manage these patients and prevent continuous inpatient stays.

Aquadex SmartFlow System
Benefits of Aquadex for HF Patients

The doctors spoke about some of the major benefits HF patients see with Aquadex outpatient ultrafiltration:

  • Taking a diuretic holiday has been shown to restore diuretic responsiveness
  • 53% reduction in risk of rehospitalizations for HF compared to diuretics
  • Early initiation of ultrafiltration in HF patients is shown to reestablish euvolemia and may decrease hospital length of stays

Ultrafiltration Patient Selection and Experience

Who benefits most from outpatient ultrafiltration?

Dr. Wencker believes Aquadex is ideal for patients who are resistant to diuretic therapy. He also stressed that using ultrafiltration with diuretics can help the diuretic process work better for patients than just using diuretics alone.

Dr. Emani spoke about how patients liked having Aquadex as an option and certainly prefer to be able to sleep in their own bed and spend time with their families, rather than in the hospital. Most of these patients have faced hospitalizations in the past and are eager to avoid readmissions. Adding amenities like a nice recliner chair helps the experience, and it’s also important to temper expectations for a process that can take a few days to produce a lasting effect.

Venous Access, Anticoagulants, and Collaboration with Nephrologists

Dr. Emani spoke to the finer points of venous access, including the ideal timing of placing venous access lines, and what types of catheters are best for controlled volume removal. Mr. Correlli spoke about how he approaches patients with anticoagulants, the importance of Heparin, and pros and cons of other anticoagulants.

The doctors agreed that outpatient infusion clinics were ideal settings for Aquadex delivery, especially if you’re combining ultrafiltration with diuretics. This allows for greater collaboration with nephrologists, who face similar volume removal challenges. Our panel explained that in their experience, nephrologists have welcomed outpatient ultrafiltration and the kidney benefits it can provide to their patients.

Watch the full webinar to hear more about how HF monitoring technologies can be incorporated into an outpatient Aquadex program.

The Reimbursement Landscape for Outpatient Ultrafiltration

We concluded the webinar by discussing the healthcare economics of ultrafiltration and the details of reimbursement, which can vary widely from state to state. Mr. Correlli spoke to how cost-effective Aquadex has been for his clinic in Maryland and Dr. Wencker noted that Aquadex is decreasing hospitalization risk for his patients, a major benefit which in turn reduces the risks of mortality.

In the past, reimbursement for outpatient ultrafiltration was a challenge, but as Aquadex becomes more commonly utilized, the reimbursement picture is getting more and more clear. As of 2022, CMS has assigned a category 3 code that covers Aquadex (0692T). This code applies a facility payment of $405.37 for the administration of Aquadex in an outpatient setting, and also provides physicians with reimbursement for each day a patient receives Aquadex. There are also additional reimbursement opportunities for placing the venous access catheters required for the therapy.

Nuwellis is also working to secure a permanent category 1 code.

Please watch the webinar to hear all the details on Aquadex reimbursement.