HRS: EP NPs spend a large amount of time on device clinic services

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BOSTON—The revenue generated by device clinic care is entirely consumed by the resources (time and salary) expended in an electrophysiology practice, asserted Suneet Mittal, MD, of the Valley Health System in New York City, during a presentation May 10 at the 33rd annual scientific sessions of the Heart Rhythm Society.

Typically for an electrophysiology (EP)-only practice, revenue is derived from procedures (ablations and devices), in-office and in-hospital patient consultations and follow-up evaluations, device clinics and ECG monitoring (Holters, event recorders, ambulatory telemetry).

“With the advent of remote monitoring, an additional burden has been placed on healthcare professionals who provide care in device clinics,” Mittal said. “We sought to determine the contribution of device clinics to our revenues.”

They collected data for the seven-person practice. Procedures were performed at two hospitals; outpatient care was delivered at seven offices. Device patients were advised to perform semi-annual remote follow-up and either semi-annual or annual in-office evaluation. The device clinic was handled primarily by three full-time nurse practitioners (NPs). Data was collected within a 12-month period from all collections of all services provided by the group, Mittal noted.

Procedures, whether ablations or devices, accounted for almost 75 percent of all revenue. Ablations/EP study accounted for 42 percent, device implants 22 percent and “other procedures" 10 percent.

Device follow-up (in-office [6 percent] and remote [4 percent]) accounted for 10 percent of revenues, similar to in-office and in-patient hospital evaluations. “However, the latter were more important from the perspective of driving procedures. The revenues from device clinic were offset entirely by the NPs' salaries; in addition, 93 percent of the NPs' time was spent on device follow-up.

“If you rely exclusively on in-office visits, the device clinic would be a profit-losing operation,” Mittal said, stating that if a clinic can reduce in-office services and extend more remote services, this could generate more revenue.

He concluded options for increasing revenue include use of lower salaried technicians and/or increased use of remote monitoring, for which global (technical and professional) reimbursement is allowed. “The latter may require use of third-party vendors, which has additional advantage of freeing up NP time for other reimbursable actions,” he added.

Mittal acknowledged the study’s limitations, including that by focusing solely on the information on collection, the researchers had no information about services that were never billed nor improperly collected.