By Kimberly Schneider, Vice President, Virtual Care Management, CardioOne
In-person cardiology visits capture only a limited snapshot of patient health. But many risks and complications emerge in the days and weeks between appointments. Integrated programs combine ambulatory cardiac diagnostics, remote patient monitoring (RPM), and chronic care management (CCM) extending care beyond the four walls of a clinic. For independent cardiology practices, this “virtual safety net” can improve patient engagement and outcomes.
What happens in the confines of a 20-minute office visit is one small part of a cardiology patient’s story.
The rest occurs in the days and weeks between visits. That’s when patients start to experience social and lifestyle changes that impact their health. A woman with heart failure gains weight unexpectedly. A man with AFib is too fatigued to walk his dog around the block. A heart attack survivor lives in isolation and slips into depression.
Too often, independent cardiologists feel powerless to address these physical and social determinants of health. Because they can’t see what happens between visits, they can’t intervene as quickly as needed, impacting their patients and their practice. Patients experience unnecessary ER visits and worse health outcomes. Practices in value-based care arrangements feel the financial impact of declining quality metrics.
Closing the gaps between patient visits requires an approach that extends care beyond the four walls of a doctor’s office. Let’s explore what a “virtual safety net” encompassing Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and cardiac event monitoring could look like for an independent cardiology practice.
In-person visits reveal only slivers of information
Despite the best of intentions, in-person visits often fall short of expectations for providers and patients.
Increased demand leads to shorter patient visits
Providers want to spend more quality time with patients in the office, but surging demand doesn’t make it possible. Heart failure prevalence is projected to increase by 46% by 2030, taxing the current supply of cardiologists and forcing them into smaller time blocks with patients than they’d like. All the while, wait times keep rising, with the average heart patient waiting 32.7 days to see a cardiologist, up 23% since 2022.
Cost, anxiousness limit patient engagement
Patients, meanwhile, are fiercely independent and may be selective about what they tell a provider for fear of being put on another medication or having a test they don’t want or can’t afford. Studies show that more than 80% of patients have concealed relevant information from their physicians during visits, while newer research indicates 1 in 5 adults have not filled a prescription due to cost.
Another real concern is “white coat syndrome,” which is estimated to affect about 31% of patients. It occurs when patients experience abnormal blood pressure spikes in the doctor’s office due to anxiety or stress.
Given the limitations of in-person visits, staying connected with patients between appointments is essential. But traditional approaches haven’t always achieved the desired results.
DIY RPM and CCM programs are hard to manage
Cardiologists trying to implement RPM and CCM programs on their own often run into staffing and technology challenges.
From a staffing perspective, most cardiology offices run lean, sometimes with just one RN or LPN. It’s not feasible for a single nurse to follow up on RPM readings, develop CCM care plans, and provide in-person care simultaneously. And if that nurse leaves the practice, the remaining staff won’t be able to fill the gap until a replacement is recruited and onboarded.
Technology poses its own set of barriers. While some longitudinal care solutions exist, many are standalone platforms requiring an extra login and password. This approach adds friction, reducing the likelihood that staff will use the tool.
Integrated care models offer a “virtual safety net”
Turnkey integrated care management and monitoring programs give cardiologists the tools they need to reach patients between visits without the staffing and technological headaches of DIY approaches. These programs provide a remote team of RNs, LPNs, and EKG techs who engage with patients outside the office, creating a “virtual safety net” that improves outcomes. They also provide technology that integrates directly into a practice’s EHR, reducing administrative burdens.
Turnkey care management programs include three core services.
Ambulatory Cardiac Diagnostics
Ambulatory cardiac diagnostic technologies—including Mobile Cardiac Telemetry (MCT), Holter, Extended Holter, and cardiac event monitors—provide continuous cardiac data beyond the limitations of an in-office ECG. By capturing rhythm activity over time, providers gain deeper clinical insight, enabling more accurate detection and diagnosis of arrhythmias and other rhythm disorders.
Remote Patient Monitoring
In an RPM program, patients receive a blood pressure cuff, scale, and pulse oximeter for home use between visits. Nurses provide outreach, bridging the gap between patients and providers by communicating concerns to practice staff. For example, if a patient’s blood pressure trends moderately higher than usual, the cardiologist can adjust their medication sooner rather than waiting for the next in-person visit, thereby helping them get back into normal range.
Chronic Care Management
CCM services are reimbursable by Medicare for patients with two or more chronic conditions — including cardiovascular disease and/or hypertension — that are expected to last at least 12 months or for the rest of a patient’s life. A care management program will provide RNs to develop CCM care plans that follow CMS guidelines, along with LPNs to perform the required monthly follow-up. These LPNs focus on addressing quality-of-life issues, including working through the anxiety and depression that can accompany chronic illness.
Combining these types of services into one turnkey solution creates real-world benefits. For example, since implementing CardioOne Connect, several of our member practices have seen improvements across their patient panel. They’ve told us that providing more touch points has given them a clearer picture of their patients’ health, improved patient engagement, and built more trust with their practice.
Interested in learning more about extending care outside the office? Start a conversation with us today.