Effective Management of Device Patients


Michelle Ferguson, RN, BSN,
Electrophysiology Nurse Clinician

Device patient follow-up has long been an extremely time-consuming task for most organizations, with at least a moderate volume of pacemaker patients. At some point, the expenditure of resources needed to maintain adequate follow-up exceeds the reimbursement and profit gained from the efforts, and it becomes a rock in the shoe that needs to be addressed. Outsourcing transtelephonic pacemaker monitoring to an independent source has been one proposed solution to this multifaceted problem.

The need to change our process of transtelephonic monitoring was precipitated by several factors. We are a large cardiology practice with a growing patient population. The number of patients we see with implanted pacemakers has increased to approximately one thousand. Although we had allocated resources for two full-time staff members to be dedicated to the monitoring, interpretation, and follow-up of these patients, concerns were expressed that this was still not adequate to handle the growth in volume that our practice was experiencing. Also, our ability to give quality attention to phone monitoring of the pacemaker patient population was significantly limited by office hours, staff availability, and weekend and holiday schedules.

Patients were increasingly forced to comply with rigid schedules of monitoring due to the growing volumes, which only resulted in frustration for staff and patients when phone checks were not completed in a timely or satisfactory fashion. In addition, nursing staff expressed concerns about overlooking indications that required additional follow-up. This situation resulted from time-constraints, and a lack of familiarity with the wide variety of software and the constantly evolving technology in the new devices being marketed.

In reviewing this situation more closely, we became aware that reimbursement for phone checks did not begin to meet the expenditures of time, staff salaries, the cost of purchasing transmitters, and maintaining service contracts on follow-up software. At that point, it became clear that we could no longer continue to perform these procedures.

Prior to outsourcing transtelephonic monitoring, many attempts were made to continue to manage these patients in other ways, such as purchasing equipment and software to assist with the process. This and other methods aimed at improving the efficiency and quality of the telephone follow-up of these patients proved to be even more time-intensive. Equipment and software limitations and the need for continued technical service support to maintain these systems made them not only resource-draining, but fiscally irresponsible. Ultimately, it was decided that outsourcing to a company dedicated to addressing these concerns was our wisest alternative.

The process of outsourcing transtelephonic monitoring was challenging, but proved to be rewarding. One of our pacemaker vendors recommended a national cardiac monitoring service that was known for its experience and leadership in the field of transtelephonic pacemaker monitoring. Our selection criteria were based on finding a service we could trust to provide excellent care to our patients, many of whom were elderly and had been with our practice for many years. The reputation of the company we selected, coupled with their responsiveness and the recommendation of our pacemaker vendor made us feel good about this decision.

Initially, patients were hesitant to trust staff that was unfamiliar to them with their phone monitoring. Reassuring patients of the need for more constant attention to their phone monitoring allayed many fears, as changing a process that had been in place for many years was disconcerting for some. Eventually, however, patients expressed satisfaction that they could complete phone checks when it was more convenient for them, particularly after business hours if they needed assistance or had a concern. To them, this benefit seemed to far outweigh the initial effort to establish follow-up with another company.

For our practice, the outsourcing of this procedure has resulted in a number of efficiencies. Relinquishing the billing and referral process for these frequent encounters relieved a burden from our business office staff. Nursing time and technical staff was reassigned to more productive tasks, which resulted in greater physician productivity and satisfaction.

From a clinical standpoint, the burden of monitoring for abnormal test results was relieved by the quality of the company we chose to outsource to. They employ extensively trained staff, including many who are NASPE-certified, to assist with interpretation of reports, as well as board-certified cardiologists professionally over-reading each exam. Our confidence was heightened by the company s objective to make our patients feel as personally cared for as possible, while providing the best possible resources and equipment to do so efficiently and effectively.

In conclusion, the patient satisfaction, financial benefits and decreased administrative burden that resulted from our decision to outsource have convinced us that this was a critical step for our practice. Cooperation with a trusted entity in the management of device patients is a must as indications for device implants change and volumes increase.

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