By Shani Cress, B.S., M. Bio, Clinical Operations Director, Rhythm Management Group
In the midst of a global health pandemic, we in the healthcare industry are challenged on how to continue to keep some of the most vulnerable patients – those with cardiovascular disease and other chronic conditions – safe and healthy. Because COVID-19 creates health risks for in-person non-emergency care, the Heart Rhythm Society (HRS) issued a recommendation in April that patients will cardiac implanted devices be seen remotely as much as possible. The pandemic has been a sea change for virtual care. In the past six months, the industry has advanced more towards remote monitoring than in the past 10 years. Remote cardiac monitoring is no longer a nice-to-have, but a critical component of care for any patient with a cardiac implanted device.
What does “optimization” mean?
Our industry talks a lot about how practices should work towards remote monitoring optimization. Because optimization can mean different things to different industries, it’s important to level-set. In the remote monitoring space, “optimization” means that all patients who are eligible for remote monitoring are connected to the system and are being monitored.
According to HRS national average data, only 45% of patients who qualify for remote monitoring are connected. In general, I see new client practices at around 60-70% connectivity before we start working with them – higher, but still well below what we consider optimized. One client we’ve had for almost two years started off with only 70% of their eligible patients connected. In just over 12 months, we got them above 95% connected and we’ve maintained that over the past nine months. Optimization is possible – but it takes work, and dedicated staff to do it – often more than you would think. To effectively monitor 1,000 patients, you need one clinician and at least three supporting administrative staff. Each patient, depending on their device, with require anywhere from 35 minutes (for ICDs and pacemakers) to one hour (for ILRs) of attention to their data.
Connectivity at implant is ideal
In a perfect world, all cardiac device patients should be connected to remote monitoring when they are implanted. This improves long term compliance, leading to better long-term connectivity and long-term outcome. Unfortunately, this is the case for only less than 50% of cardiac device patients – the other 50% are out there waiting to be adding to the network.
Getting patients connected later is more challenging, and requires a high-touch, hands-on approach. For these patients, onboarding is critical to ensuring that after the patient gets connected, they stay connected. We have worked to perfect our process on how to educate patients and explain remote monitoring to them so that they remain compliant. While initial connection is important, continuous connection is vital – and nowhere is this more important than for ILR patients, some of the most vulnerable within this space.
As an example, an ILR patient we had earlier this year had no alerts on their transmission, but when one of our clinicians took a look at their chart, they saw a significant pause in the patient’s rhythm. The clinician conferred with the clinical team and then communicated the finding back to the patient’s physician office. Within three hours of the transmission, the patient was scheduled for a pacemaker implant.
Routine scheduling drives patient—and practice—health
While some practices look at remote patient monitoring simply as an alert service, it’s more than that. Faster alerts are great, but if practices don’t have another regularly scheduled transmission, then they aren’t getting a full picture of the patient and they aren’t optimizing their billing practices.
If there’s no alert, it’s critical to ensure a report is scheduled (e.g. for every 31 or 91 days) to go to the patient’s physician so they have insight into what’s going on and can assess whether or not the plan of care is working. Triggering these regular patient reports ensures care transparency – and it allows the practice to bill for a set number of remote transmissions each year, depending on the device.
Moving beyond status quo
In addition to keeping patients connected and scheduled, optimized practices must make sure all their processes are working properly, to ensure they can intervene and provide modifications when necessary. This can’t happen if the practice’s vendor sites are full of non-compliant, disconnected, and deceased patients, as was the case with one leading academic center when we started working with them.
This is where a sophisticated technology platform that aggregates patient rhythms from across vendor sites can be very helpful. For this center in particular, our administrative and clinical teams worked together to clean up their sites, get them on our high-tech RhythmSynergy platform, and get them back into compliance with connectivity above 95% and scheduling above 98%.
Patient care and practice care
Practice optimization is about maximizing patient care and practice care – in essence, you do great work for your patients, and you should be reimbursed accordingly. Working with a remote monitoring partner lifts that burden from your team while ensuring your patients are being looked after outside the practice walls.