The Cardiovascular Group (CVG) comprises 16 cardiologists—four of whom implant EP devices—and serves five hospitals and eight satellite campuses throughout the greater Atlanta, Ga., area. In the fourth quarter of 2009, the group began integrating data from implantable cardiac devices—remotely transmitted from their patients’ homes—directly to its EMR. While CVG had been reaping the benefits of remotely interrogating EP devices via St. Jude Medical’s Merlin.net Patient Care Network since late 2008, which included increased reimbursement revenues, reduced overhead costs and decreased manual processes, the benefits were enhanced when those data became integrated with the practice’s EMR (GEMMS ONE).
As a high-volume facility, CVG implanted approximately 1,530 cardiac devices (including pacemakers, implantable cardioverter-defibrillators [ICDs] and biventricular ICDs [CRT-Ds] from all manufacturers) between 2008 and 2010 (see figure, page 11). Previously, patients with implanted cardiac devices were required to visit the office for device interrogations, which were typically conducted quarterly. However, when the practice implemented Merlin.net, two of those annual device interrogations could occur remotely via the Merlin@home wireless transmitter. St. Jude Medical’s ICD, CRT-D, CRT-P and traditional pacemaker technologies are tracked using RF telemetry that remotely monitors patient devices on a daily basis, which enables caregivers access to patients seven days a week, 365 days a year, and leads to a reduction in delays between event and clinical intervention. Recent research suggests remote monitoring leads to:
- A 50 percent relative reduction in the risk of death1;
- Improved survival rates: 13 percent for ICDs and 15 percent for CRT-Ds1; and
- An 80 percent reduction in time to clinical intervention2.
The paradigm shift of remotely following asymptomatic patients allowed CVG to spend more time with symptomatic patients, as well as to expand its business. In addition to the time saved by physicians and staff through remote monitoring, utilizing Merlin.net for device interrogations can result in greater economic value. CMS reimburses approximately $29 to $35 more for monitoring remote interrogations over a three-month period, compared with individual quarterly office visits for patients with pacemakers or ICDs/CRT-Ds. From 2008 to 2010, CVG billed for 2,645 in-office device interrogations for pacemakers and ICDs across all its manufacturers, generating revenue of approximately $170,6003 (see figure, page 11). For example, if you took a comparable physician practice with the same volume that was not employing remote interrogations, and applied an additional $30 to half of those 2,645 visits, as if it had been using Merlin.net, the total revenue for that same period would have been about $210,300, or a 23.3 percent increase.
In 2009, its first full year of using Merlin.net, CVG generated about $46,300 in revenues from device interrogations for St. Jude Medical’s devices alone, which boosted its an annual revenue to $71,668 in 2010—a year-over-year increase of 64.6 percent (see figure below).
|Cardiovascular Group Remote Interrogations for St. Jude Medical Devices|
|Quarterly Procedural Growth||321%||108%||-54%||-14%||65%||45%||30%|
|2009 Q-o-Q Procedural Growth||250%||38%||-4%||170%|
|2009 Q-o-Q Revenue Growth||161%||35%||-5%||169%|
|Annual Revenue: $46,317||Annual Revenue: $71,688|
|Includes technical/professional CPT codes for St. Jude Medical ICDs and pacemakers (93294, 9329526, 93296 & 93295)
All revenue has been normalized to 2010 Medicare Physician Fee Schedule in Atlanta (June 1-November 2010), which is 200-300 percent lower than average practice revenues.
Practice management considerations
The Merlin.net integration with the GEMMS ONE Device Manager occurred soon after the EMR rollout. Prior to this integration, individual patients could have two or three paper records for both clinical and device information. Even though the nursing staff was utilizing Merlin.net, their process was to print out all clinical events, which were stored as PDF files. Then, the staff would scan the files and attach them to the patient’s record, as well as manually enter device data into the record.
By seamlessly integrating patient interrogated reports and data between these two systems, the clinicians at CVG have one centralized electronic record with all their patients’ cardiology