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An estimated three million-plus patients live in the United States with implanted cardiac devices, with 400,000 implanted annually. Follow-up care for these patients continues to evolve and become more challenging due to increasing clinical complexity of patients and diagnostic device features. 

Cardiac implantable electronic devices (CIEDs) include pacemakers, implantable cardioverter defibrillators (ICDs) and loop recorders. Patients who receive them must be monitored for device functionality and the physiological data it yields. For this they have two options: in clinic (IC) visits and remote monitoring (RM). One method is costly and allows monitoring every three months; the other provides daily information with increased efficiencies, superior clinical outcomes, and cost savings. Yet, as a whole, the health care industry has been slow to embrace the better choice. 

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RM offers advantages for clinicians and patients to minimize some of the complexities in cardiac monitoring while maximizing outcomes. Multiple randomized trials and registries have clearly determined the superiority of RM over IC visits including: 
• Improved survival rates by over 50% 
• Improved patient quality of life 
• Improved patient compliance comparing RM to IC follow-up 
• Faster detection of actionable clinical events 
• Reduction in clinical CIED evaluation time by 58% 
• Decreased hospital length of stay by 18% 

Now that the COVID-19 pandemic has given patients reason to avoid health care facilities, it’s time to consider fully incorporating remote monitoring into cardiac care for the benefits — financial and clinical — it provides. 

The financial case for remote monitoring
The Centers for Medicare & Medicaid Services Current Procedural Technology code for reimbursement includes evaluation for pacemakers and ICDs. Each contains a professional and technical component. The average reimbursement, comparing these two methods, is nearly identical. Current CMS averages across the U.S. for these services show the global reimbursement difference between IC and RM is not a factor: $49 versus $56, respectively, for pacemakers and $66 versus $64 for ICDs. 

The 2008 Heart Rhythm Society/European Heart Rhythm Association Expert Consensus on Monitoring CIED set international guidelines for minimum device follow-up frequency, though they vary depending on ICD, pacemaker, and implantable loop recorders (ILRs). Health care providers often choose to perform follow-up visits after device implantation every three to six months for pacemakers and ICDs. For RM and IC checks of pacemakers and ICDs, monitoring periods for reimbursement are set up for 90 day periods and can be charged up to four times per year. With ILRs and cardiac resynchronization therapy (CRT) monitoring for heart failure, separate codes have been established that are based on charging for reimbursement every 30 days. 

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