CHICAGO—Setting up a telemonitoring program for the 1,900 device patients cared for at the Heart Center of the Rockies in Fort Collins, Colo., was no easy feat for Lisa Diederich, RN, a certified cardiac device specialist, and company. However, it transformed patient care while improving the bottom line, said Diederich in a presentation June 7 at MedAxiom’s Cardiovascular Service Line Symposium.
With 15 outreach centers across three states and two to three device implants per week, it seemed reasonable for the Heart Center to transition to telemonitoring in 2006. The reimbursement scenario was potentially favorable, too. In fact, 2012 reimbursements for remote monitoring vs. in-clinic monitoring are $62.57 and $38 (with no programming), respectively. These same reimbursements for ICDs are $94.77 vs. $66 (with no programming), respectively.
“To have a successful device clinic you have to know and truly believe in the benefits of remote monitoring,” Diederich offered. “We have seen tremendous benefits."
The facility follows Medicare billing guidelines, which means four remote follow-ups per year and one in-office follow-up. Diederich said that pacemaker and ICD revenue generated from telemonitoring equated to $794 and $8,195 in 2007. However, in 2011, these numbers jumped to $86,999 and $210,357, respectively.
“One of the big things for us has been the economics of it,” she said. “We are able to see more patients and bill more frequently, thus improving revenue."
Remote monitoring has decreased the number of patients headed to the operating room and allowed staff to make better medical decisions faster, she added. Besides closer surveillance of device patients with remote monitoring, Diederich said that time from event to clinical decision was drastically improved, at 4.6 days vs. 22 days for in-office.
Many patients do not have landlines, so the Heart Center mailed them transmitters that plugged into cell phone chargers in an approach called “point of care pairing.” With point of care pairing, device patients are monitored one day post-implant, which has decreased the time to intervention.
“Compliance has improved immensely now, between 90 and 95 percent,” she said. “We now see fewer patients going to the ER,” she added.
Diederich said there were EMR and workflow challenges, but once they overcame them they saw multiple benefits.“You have to have a plan,” she said. “As devices and remote websites evolve, you will have to have a plan. You can’t move backwards, only forward.”
Specifically, Diederich and staff faced new EMR woes. The facility transitioned from a cardiology-specific EMR to a general practice EMR in May 2010, making it difficult to customize flow sheets and templates. Staff had to create all new templates, adding 10 to 20 minutes to each device check. However, once the facility was enrolled in the connectivity pilot program, workflow was streamlined and 10 to 17 minutes were saved per patient.
“You must remember to make your needs known to device companies and tell them what it will take to make your workflow more efficient,” she said.
Lastly, Diederich outlined the benefits of remote monitoring:
- Closer surveillance of device patients with rapid notification of alerts;
- Ability to use diagnostics to follow up on medication changes, percentage of arrhythmias and biventricular pacing, without having patients travel to the clinic;
- In difficult economic times, it saves patients the travel expenses of getting to the clinic; and
- The ability to review more patients and bill more frequently, thus improving revenue.
“Remote monitoring is a great way of improving patient care while also improving your revenue,” Diederich summed.