United Healthcare: CardioNet is “unproven”

By: Brian Dolan | Jul 7, 2010        

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CardioNet patient monitorMore bad news on the reimbursement front for CardioNet and other mobile cardiac outpatient telemetry service providers: United Healthcare told the company that it is maintaining its position that “outpatient cardiovascular telemetry is unproven for managing cardiac arrhythmias” and as a result it will not cover the service for its members. CardioNet, of course, disagrees and promised to continue to work with the payer to demonstrate the efficacy of its MCOT services.

The update from CardioNet about United Healthcare’s continued stance follows a similar move by the Centers for Medicare and Medicaid Services (CMS) that proposed last week that the technical component of mobile cardiovascular telemetry (CPT Code 93229) remains carrier-priced for calendar year 2011.

Highmark CMS originally paid $1,123.07 for MCOT services when the CPT code took effect in early 2009, however, by July Highmark CMS announced plans to reduce the reimbursement rate substantially. On September 1, 2009 a new rate of $754 per service, a 33 percent reduction from the original $1,123, took effect. CardioNet was disappointed: “This surprise decision by HMS on July 10, 2009 must be readdressed and not be allowed to put at risk either the investment in new technologies or the benefit to the patients we serve,” the company wrote in a statement.

Since then the company has had to tighten its belt and cut operations costs to adjust for the lower reimbursement rate. The news that United Healthcare, one of the largest payers in the US, maintains its policy on not reimbursing for CardioNet’s services certainly points to the climate of wireless health reimbursement today.

Here’s a rundown of the CardioNet reimbursement saga to date:

February 2009: CardioNet looks to dominate wireless medicine
April 2009: CardioNet to buy Biotel, enter clinical research
May 2009: CardioNet’s new offering: Wireless diagnostics for sleep apnea
May 2009: CardioNet quashes CMS reimbursement rate cut rumors
July 2009: CardioNet eyes diabetes, hypertension, neurology
July 2009: CMS slashes CardioNet reimbursement rate
July 2009: No deal: CardioNet cancels Biotel acquisition
September 2009: Cardiac monitoring reimbursement cut effective today
September 2009: Rumor: Philips to acquire CardioNet?
September 2009: CardioNet enhances cardiac monitoring with in-depth data
November 2009: CardioNet CEO: Not able to sustain operations
December 2009: CardioNet hires financial advisor, mulls sale?
February 2010: CardioNet: 300,000 hearts monitored wirelessly
June 2010: CardioNet’s long-awaited new leader: Joe Capper

  • David Albert, MD

    The question remains as to whether an “immediate” diagnosis of afib makes a significant clinical difference. iRhythm does not think so and now United Healthcare chimes in. This bodes ill for an ultimate national decision by CMS. Cardionet has been an mHealth pioneer but the old adage that “pioneers are people with arrows in their backs” seems appropriate for them.

  • http://mobihealthnews.com Brian Dolan

    David, I agree. ZDNet’s Dana Blankenhorn added some good commentary, too: http://healthcare.zdnet.com/?p=3799

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