Cardiac Electrophysiology Laboratory, Department of Cardiology, Hofstra North Shore-LIJ School of Medicine, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
Europace. 2013 Jun;15 Suppl 1:i54-i58. doi: 10.1093/europace/eut109.
Demographic and technological changes are driving increased utilization of cardiac implantable electronic devices (CIEDs) remote monitoring. In the USA, fee-for-service model of healthcare delivery, services rendered are valued based upon time, intensity, and technical or practice expense costs. As a consequence of this perspective, and to contain spending, Medicare has grouped physician services into families. Spending within each family of services must, by law, remain budget neutral. Cardiac implantable electronic devices monitoring services, remote and in-person, are grouped into one family. As the volume of services within this family increases, the individual encounters are destined to be discounted into ever decreasing portions. However, if the value of remote monitoring is demonstrated to extend beyond the previous boundaries of in-person interrogations, a rational request can be made to reconsider the relative value of remote monitoring. Outcome data supporting the value-added benefits of remote monitoring are rapidly accumulating, including (i) patient convenience, with reduced use of office services, (ii) equal safety compared with in-person evaluation, (iii) shorter detection time to actionable events (arrhythmias, cardiovascular disease progression, and device malfunction), (iv) reduced length of stay for hospitalizations, (v) reduced inappropriate shocks, (vi) increased battery longevity, and (vii) a relative reduction in the risk of death. Fully automatic wireless technology, only recently widely implemented, will add considerable clinical efficiencies and further increase the value of remote monitoring. The U.S. challenge will be to appropriately define the relative value of CIEDs remote monitoring now that outcome data have demonstrated its value extends beyond in-person interrogation.
人口统计学和技术变革推动了心脏植入式电子设备（CIED）远程监测的应用增加。在美国，医疗服务的按项目付费模式根据时间、强度以及技术或实践费用来评估服务价值。由于这种观点，为了控制支出，医疗保险将医生服务分为若干类别。每个服务类别内的支出必须保持预算平衡。远程和现场的心脏植入式电子设备监测服务被归入同一类别。随着该类别服务量的增加，个体服务的折扣幅度注定会越来越小。然而，如果远程监测的价值被证明超出了现场检查的先前界限，就可以合理地要求重新考虑远程监测的相对价值。支持远程监测增值效益的结果数据正在迅速积累，包括：（i）患者便利性，减少对办公室服务的使用；（ii）与现场评估相比具有同等安全性；（iii）对可操作事件（心律失常、心血管疾病进展和设备故障）的检测时间更短；（iv）住院时间缩短；（v）减少不适当的电击；（vi）电池寿命延长；以及（vii）死亡风险相对降低。最近才广泛实施的全自动无线技术将大大提高远程监测的临床效率，并进一步增加其价值。美国面临的挑战是，在结果数据表明远程监测的价值超出了现场检查的范围之后，应如何恰当地定义 CIED 远程监测的相对价值。
