Montefiore Medical Center

Customer Profile

Montefiore Medical Center is a premier academic medical center and the primary teaching hospital of the Albert Einstein College of Medicine in New York City. As a recognized leader in heart rhythm diagnoses, treatment, and research, the medical center is also known for its commitment to embracing technology innovation and providing outstanding care.

Challenge

In 2018, Montefiore began searching for a partner that could help it initiate and manage a remote monitoring program for patients with implantable cardiac devices. The medical center’s patient population was growing and Dr. Luigi Di Biase, MD, PhD, the Section Head of Electrophysiology and Director of Arrhythmia Services at Montefiore, saw the need for a more efficient process for caring for patients with these devices.

At the time Montefiore had about 1,000 patients with implantable devices, but those patients were regularly checked on site, rather than being continuously remotely monitored.

“As a high-volume clinic, it was becoming increasingly difficult to manage these checks at the clinic, and they were taking a significant amount of resources,” explains Di Biase, who conducts research on heart failure cases treated with cardiac resynchronization therapy devices. “We also knew that many of our patients with implantable devices weren’t coming in for regular checks, which was very concerning.”

Solution

The medical center’s physicians hoped that a remote management partner would help engage more patients and enhance care, while also freeing up internal resources for other patient care initiatives. “Remote monitoring is the standard of care, and we wanted to provide that to our patients,” says Di Biase. “But we needed a partner that could help us do that efficiently.”

After considering various remote management partners, Montefiore selected Rhythm Management Group, which provides practices and health systems with service and technology solutions to create, improve, and scale their remote monitoring programs.

“With Rhythm, it was clear that they were willing to go above and beyond to meet our unique needs and workflows, versus the other partners that we looked into,” explains Di Biase, noting that this was very important to the medical center because their patient population was growing so rapidly. “We knew our needs might change over time.”

Rhythm began working with Montefiore in January 2018. Its services then, and now, include identifying, engaging, enrolling, and onboarding patients. Rhythm’s clinical and service teams also continuously monitor patients, share insights with the practice, resolve device connection problems, and improve transmission scheduling compliance to optimize reimbursement.

Since improving patient engagement was so important to Montefiore at the outset of its partnership, Rhythm provided the medical center with an on-site onboarding specialist. This individual worked in the practice for six months, solely focusing on identifying and enrolling eligible patients. This approach was so effective that it’s now one of Rhythm’s standard offerings to all large practices and health systems.

A few months into the partnership with Montefiore, Rhythm also launched a remote management technology platform. The platform, which was built based on insights from physicians, including Dr. Di Biase, enables staff and physicians to review reports and transmissions in one central location. Rhythm also color-codes the transmissions—red, yellow, or green—to indicate the urgency with which they should be reviewed.

“The accuracy of the interpretations is extremely high, and that has helped us build a high level of trust in Rhythm,” notes Di Biase. “We are confident about the findings, which makes our reviews more efficient and gives us peace of mind that no critical clinical findings will slip through the cracks.” As an extra layer of protection, Rhythm’s clinical team also sends real-time alerts to physicians and staff whenever transmissions reveal potential serious health problems. The alerts are based on thresholds determined by Montefiore’s physicians and other clinical team members.

Results

Since partnering with Rhythm in late 2018, Montefiore has nearly tripled the number of patients enrolled in its remote monitoring program. Montefiore’s program is also one of Rhythm’s fastest growing, with the team onboarding between 80 to 100 new patients weekly. In total, more than 3,100 patients are enrolled, and more than 90% are engaged and connected to devices. That’s more than double the typical connectivity rate of 40% to 45% experienced by most remote monitoring programs. “We’re very happy with the connectivity and engagement rates, and are confident that we’re not missing newly eligible patients,” says Di Biase, noting that patients are also extremely happy with the remote monitoring program. “They know a critical health issue will be identified by the practice, and they also appreciate that remote monitoring reduces the number of times they have to come into the practice for in-person device checks.” In addition to enhanced patient engagement and satisfaction, other benefits of Montefiore’s remote monitoring program include:

Improved practice efficiency
Prior to partnering with Rhythm, Montefiore was struggling to allocate adequate staffing and resources to the high volume of in-office checks required for patients with implantable cardiac devices. Remote monitoring has significantly reduced the number of in-office checks required. “Without remote monitoring, we wouldn’t have had the resources to scale and serve more patients,” explains Di Biase. “We would have had to hire additional staff.” With more time and resources, Montefiore staff have been able to focus more on direct patient care. Prior to partnering with Rhythm, the medical center dedicated several staff members to managing the cardiac monitoring program and the in-office device checks, including three physician assistants (PAs). Now, those individuals can focus on other high-acuity, revenue-generating services.

Streamlined physician workflows
Since Montefiore’s program is scaling so quickly, Rhythm is working closely with its physicians to create more efficient workflows, review processes, and alerts. For example, Rhythm has customized the physicians’ alerts and alert thresholds based on their unique preferences. And, as Rhythm has continually optimized its technology platform, it has regularly requested and incorporated Montefiore’s feedback. “They’ve been eager to learn about the types of workflows, reports, and analytics that will most benefit us from an efficiency and care perspective,” says Di Biase, who recently worked with the company to develop an algorithm to better identify patients with persistent AFIB.

Enhanced patient care
Rhythm has helped nearly triple the number of patients engaged in Montefiore’s program. This means more patients are receiving the standard of care. It also means physicians can intervene sooner when potential health issues arise. To underscore that value, Di Biase points to a recent case involving a patient with an implantable loop recorder for syncope. As a result of continuous monitoring, Rhythm’s clinical team noticed that the patient was having sinus pauses up to 10 seconds in duration. Rhythm issued a red alert to Montefiore, and one of their physicians immediately sent to the emergency department and implanted with a pacemaker. “This is just one of many examples of how we can intervene more quickly because of Rhythm,” says Di Biase. “The program is helping avoid unnecessary emergency department visits, hospitalizations, and readmissions.”

Higher reimbursement
The growth in patient engagement has enabled the medical center to increase billing for CPT codes 93294, 93295, 93297, and 93298. In addition, the medical center has benefited from Rhythm’s ability to ensure patients are on a regular transmission schedule. Since implementing Rhythm, the practice has billed approximately $1 million annually for remote monitoring services. As noted earlier, a primary reason Montefiore selected Rhythm was its commitment to meet the medical center’s unique needs and objectives. Nearly three years into the partnership, Di Biase says that commitment has never wavered. “Whenever I have new ideas or suggestions, Rhythm works with me to make them happen. I’m confident that our partnership is benefiting patients, which is the most important thing.”