IRhythm

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iRhythm sells the MD the ZioPatch and is telling the MD to bill, hookup, technical fee and profee! How can the MD legally bill the technical fee when iRhythm is still doing the scanning and analysis?? Doesn't sound correct to me.
thoughts??
 


















Anonymous said:
iRhythm sells the MD the ZioPatch and is telling the MD to bill, hookup, technical fee and profee! How can the MD legally bill the technical fee when iRhythm is still doing the scanning and analysis?? Doesn't sound correct to me.
thoughts??
Click to expand...

What they are doing is setting up fee-for-service agreements with the practices for only commercial insurances and bcbs then having the practice bill the holter global code. Then with Medicare having the practice split bill so they dont get caught in the anti-markup rule. Soon the practices will catch on that they are losing money with the amounts iRhythm is asking for reimbursement with those commercial and BCBS patients.
 






How does this apply to what irhythm does? You should do your homework before posting.

"Historically, the "anti-markup rule" applied to the technical component (TC) of diagnostic tests that were ordered and billed by a physician, but purchased from another physician. The billing physician could not mark up the purchased test, which meant that the Medicare payment could not exceed the performing physician's net charge, the billing physician's actual charge, or the fee schedule amount — whichever was lowest."
 






The IRhythm patch only is a one lead device and as mentioned earlier it is not trans telephonic. It does not really have a code that fits it as it is not transtelephonic and it not really a holter because there is no derived 12 leads. I think doc's like it because the patient never has any abnormals and the it's stick and go with no patient feedback during the test and no strips to download for the nurse/tech. However when Medicare does give it a code I can see the hook up being nothing maybe $10 since it's a peel and stick. The Technical component being small since it's download and format no ongoing analysis and the Professional code probably being under $25 since it's only one lead. It's a good idea but there will be no money in it for anyone in the end.
 






How much are docs making now with their Holters? $25, give or take? Ask an EP if they'd prefer to spend a couple grand buying a dozen Holters (which have about a 15% diagnostic yield on average and would need to use them on 100 patients before they even begin to turn a profit) only to have 85% of those patients come back in and waste even more time and resources because they didn't find jack or put a Zio Patch on the patient (which are on consignment and thus require no capital investment) that they're going to wear continuously for up to 14 days (even when they shower and exercise and sleep)? Which device do you think is going to have better results? Yeah, the margin is going to be slightly less (break-even for Medicare patients but commercial providers reimburse more than the cost) but who cares when you find a patient that needs a can or an ablation that would've otherwise gone undiagnosed? And no, the device doesn't transmit but what percentage of patients coming through are potentially high risk and need an MCOT or the like? I'd say 10% tops. For those patients mobile telemetry is certainly ideal but they're a small subset.

Most docs use Holters because it's been the norm for the last 25+ or so years, not because it yields great results and certainly not because they're big profit contributors. The Zio Patch, or something like it, will be the industry standard in the coming years. And once mobile technology is scalable and can be implemented profitably, your average multi-lead MCOT will go extinct, just like the Holter is seeing now.
 






Bravo! Good to finally see someone on this site that actually knows the industry and the true economics involved. The MCOT crap is nothing but spin and fabricated value.
 






Anonymous said:
Bravo! Good to finally see someone on this site that actually knows the industry and the true economics involved. The MCOT crap is nothing but spin and fabricated value.
Click to expand...

I wouldn't say it's complete crap (I'm the previous poster by the way) as there is a need. But I do think that need is mostly the result of poor yields due to low compliance or other limitations of current device options, primarily because they either don't record long enough (Holters) or because they're too complicated and/or bulky (both Holters and Event Monitors) for the majority of patients to use as consistently as they're supposed to. There are always going to be those patients, though, that put off a CD or EP visit too long to the point where their symptoms require nothing less than an MCOT.

But it still always comes down to compliance and that's an area where iRhythm has everyone beat.
 












This is a nice discussion on page 2. I also work in the industry and have seen MCOT as in a death spiral. MCOT is marketed as an interventional system, which is a mistake that led the whole industry down the garden path. We've got a system that has the benefits of telemetry at a cost that's competitive with traditional holter and event with considerably better compliance than the traditional devices.

I've never viewed CardioNet as our competition. ZioPatch is our competitor because it is a screening tool for more highly reimbursed procedures. That's why St. Jude has such an interest in it. The money isn't in the service. The money is in finding previously undiagnosed patients and performing ablations, inserting pacemakers, etc. Diagnosis requires higher yield and patient compliance ensures both.
 






Precisely. Hell I bet there are even docs out there that would be willing to lose a couple bucks on each test if it leads to an additional pacemaker or ablation each month. And yes, it's the St. Jude reps that stand to gain a lot too if it's the doc utilizes one or more of their devices.
 






Anonymous said:
How much are docs making now with their Holters? $25, give or take? Ask an EP if they'd prefer to spend a couple grand buying a dozen Holters (which have about a 15% diagnostic yield on average and would need to use them on 100 patients before they even begin to turn a profit) only to have 85% of those patients come back in and waste even more time and resources because they didn't find jack or put a Zio Patch on the patient (which are on consignment and thus require no capital investment) that they're going to wear continuously for up to 14 days (even when they shower and exercise and sleep)? Which device do you think is going to have better results? Yeah, the margin is going to be slightly less (break-even for Medicare patients but commercial providers reimburse more than the cost) but who cares when you find a patient that needs a can or an ablation that would've otherwise gone undiagnosed? And no, the device doesn't transmit but what percentage of patients coming through are potentially high risk and need an MCOT or the like? I'd say 10% tops. For those patients mobile telemetry is certainly ideal but they're a small subset.

Most docs use Holters because it's been the norm for the last 25+ or so years, not because it yields great results and certainly not because they're big profit contributors. The Zio Patch, or something like it, will be the industry standard in the coming years. And once mobile technology is scalable and can be implemented profitably, your average multi-lead MCOT will go extinct, just like the Holter is seeing now.
Click to expand...

Hold on the device is a one lead non-transtelephonic device that no one can make any money on. Your telling me your going to put this on a post A-Fib study patient and not get any results back for three weeks! I would love to be the attorney on that case. "Doctor were there any options for data to be transmitted continously for my patient?" "Uh er yeah I think so." Are they not just billing one Holter code over the two week period and paying for the device up front. Does anyone know how they are billing this device.
 






Please tell us which device is "transmitted continuously". I am not sure of which device you are thinking of.

If you need a device that is "transmitted continuously" for post AF monitoring, why doesn't HRS recognize that? Again, please answer question one first.

If you are monitoring an asymptomatic post ablation patient 6 months out, why would an EP need the results in a day and they cant wait a week or two or even three? Think of your answer first..... because you need to look at question 2 again.

I know a rep with 2 week monitor class (that cannot even read ECGs) may think the MD needs to know at 2am, but the governing body for EPs does not think so.
I have to agree that I would also love to see the idiot lawyer in court ask that stupid question.
 












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