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Remote Monitoring became an imperative for Heartbeat Cardiovascular Group to detect arrhythmias earlier, identify medical device and connectivity problems among its patient population, and unlock revenue opportunities it had previously been missing.

We spoke with John Mckenzie, MD about how the 10-person practice in Glendale, CA, is leveraging Rhythm Management Group’s Cardiac Remote Monitoring (CRM) technologies and services to achieve the ‘virtuous triangle’ of improving patient care, enhancing the practice’s brand, and generating revenue — without adding any additional administrative burden to the staff.  

Q: What has been your practice’s journey to cardiac remote monitoring?

A: As a clinical electrophysiologist, we’re a busy practice. When remote monitoring first came out, we weren’t really doing a lot of it. There were a couple of reasons. Outcomes studies were lacking, the technologies required an upfront investment including more staff to manage the program, patients were concerned cardiac remote monitoring would supplant office visits so they were not ready to engage. But we were basically garnering zero of the revenue available.
When the outcomes studies relative to remote monitoring became very good, it quickly turned into an agenda item for the practice, and it also became clear that it was going to require a lot of work to undertake on our own. 

Q: Once Cardiac Remote Monitoring became imperative, how did your vision for it evolve?

A: I have conceptually created, in my mind, this “virtuous triangle” of a model for a practice where the key elements are, 1) Is this good for patient care? 2) Does it improve or enhance the brand of the practice, make us look more on the cutting edge and comprehensive? And then, 3) Does it generate revenue? If those three boxes are checked, this is something that our practice is going to be interested in — and Cardiac Remote Monitoring definitely fits that pattern. 

Q: How does Rhythm’s platform enable you to achieve that virtuous triangle?

A: They understand that 90% of our patients are coming from within several zip codes, all in fairly close proximity. I don’t have the needs of the Cleveland Clinic where half the patients are hours away. The value of cardiac remote monitoring for us, instead, is catching arrhythmias earlier and identifying device problems early. The key initial steps were Rhythm Management Group deploying personnel to directly communicate with our patients in their native language, help them to connect, and determine which family members should be involved. A lot of that is easily lost in translation. Half of the patients on devices are sort of savvy, but there are a lot of 80-year-olds who are not. Many are cell phone averse, they’re technology averse, and you really need a personal touch to get and keep them connected. 

Q: You mentioned that patients can be skeptical about Cardiac Remote Monitoring. Have you heard any direct feedback from people who are participating in the program?

A: Our patients are satisfied when they understand that we’re not doing this in place of their office visits. We’re monitoring them remotely to provide additional safety and additional treatment when necessary. And they’re paying for this, so they have to understand why we are doing it. That makes it important that the messaging to patients is clear and effective. 

I would say 80-90 percent of the time patients feel that participating in cardiac remote monitoring is not an issue. The other 10-20 percent of patients ask if they really need it, or they want to know why they are now receiving a monthly bill for the service. I’m not even going to leave that explanation to chance. I’m going to get out in front of this and make sure to communicate with the patient that the doctor has selected them to participate. 

Q: Which additional aspects of the practice — whether operations, staff efficiency, or workflows — has Rhythm positively impacted?

A: We’re right in that evidence-based algorithm. It’s providing everything that the studies show that it provides. As a result, we say in our practice that we save a stroke a week by catching early AFib. We catch batteries that are dangerously depleted because batteries decay exponentially and not linearly, so that depletion can be unpredictable. Or we receive an alert about a patient who has not been to the office in two years.

It’s also important that cardiac remote monitoring is a part of a patient care plan and that we are billing appropriately for it. Ultimately, that means it’s a priority for the data to be integrated into the patient’s medical record in the EMR.

Q: Has your practice realized any cost savings since introducing the program?

A: Yes. We are generating revenue. Patients are recognizing that we are taking better care of them. We’re getting the outcomes we’re looking for. 

Q: Has Cardiac Remote Monitoring added any workload or inefficiencies to your practice’s staff?

A: We didn’t bring Rhythm Management Group in to solve a problem that we had with remote monitoring. We simply weren’t doing it. Now, we’re providing a new service and partnering with them so our work doesn’t go up. The key is that my office staff isn’t doing the actual work. The reports come in, they find their way to me quickly, and we’re satisfied.

Q: Where do you see your practice going with Cardiac Remote Monitoring in 1-3 years?

A: The digital health train has left the station. There’s going to be more and more of this due to payment models to leverage the technology. 

One thing we’ve learned over the years is that when the Centers for Medicare & Medicaid Services (CMS) decides it is going to pay for something, CMS has already done an intense proforma and knows there’s value in that. We all believe there’s significant value in remote patient monitoring. It’s meeting my virtuous triangle: patients like it, they see us in a different light, and it is generating revenue. Cardiac remote monitoring makes a lot of sense. Expounding on that — although I don’t think it’s widely felt this way yet in most practices — I believe as RPM continues proving its value by improving how we manage heart failure, we will be able to use RPM for other types of diseases as well moving into the future. 

Q: When your practice began its CRM journey, what led you to partner with Rhythm Management Group instead of other RPM companies?

A: We found that remote monitoring companies are in two distinct camps: strong on software or strong on services. Our real challenge is connectivity with patients, making sure that they’re staying connected. For our practice, it was very important that Rhythm Management Group was strong on both services and software.