WellPoint: Mobile heart monitor is “experimental”

By: Brian Dolan | Aug 3, 2010        

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CardioNet patient monitorDuring its second quarter conference call, CardioNet noted that WellPoint had also called mobile cardiac telemetry monitoring services as “experimental” and unproven — United Healthcare made a similar conclusion last month. The commercial payers’ reimbursement decisions are important for CardioNet, which saw a payer revenue mix of 34 percent Medicare and 66 percent commercial for the three month period ending June 30, 2010.

During that period, CardioNet brought in $20.1 million in gross profit, about 63 percent of its revenues, but still a decrease from the $26.3 million it raked in during the same period last year. The company said that this past quarter’s revenue was largely affected by CMS’ decision to reduce its reimbursement rate for the company’s service by 33 percent. Commercial payers duly followed suit. According to the company, however, a 12 percent increase in patient volume (over Q1 2009) helped offset the rate decrease.

Here’s how new CEO Joe Capper sizes up the CMS reimbursement kerfuffle:

“We believe that CMS is interested in establishing a national price but continues to struggle with valuing our unique service offering which does not necessarily fit into its traditional valuation methodologies. Despite this challenge, it is imperative that CMS establishes a valuation that will ensure all Medicare beneficiaries have appropriate access to this life-saving technology. The Proposed Rule is currently in a comment period and we will continue to provide CMS with information to help them understand the costs associated with the MCOT service and the benefits it provides to patients and physicians. CMS’ Final Rule for 2011 rates is expected by early November. Additionally, the lack of national pricing may create confusion among commercial payors on how to value our service. We will continue to work with CMS to achieve national pricing and with commercial payors to ensure that their patients gain access to the clinically proven benefits of CardioNet’s MCOT.”

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
July 2010: United Healthcare calls CardioNet unproven, experimental

  • David Albert

    I would like to see studies that are sufficiently powered to see whether there is a clinically significant difference in outcomes from MCT vs auto-triggered event recorders vs long-term full disclosure (iRhythm-type). Payors are not convinced there is a statistically-significant difference whether it is in “time to diagnosis” or, more importantly, clinical outcomes which is worth the increased cost of wireless solutions like MCT. If Cardionet, Lifewatch, Philips et al won’t fund such a study then CMS needs to do it under the Comparative Effectiveness banner and money.

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