Balancing cost and care: How cardiac physicians and health care providers can adapt to changing reimbursement structures

Cardiovascular disease continues to take a devastating toll on millions of patients each year, often striking suddenly and without warning. As the health care industry shifts toward value-based care — emphasizing improved outcomes and cost efficiency — physicians are adopting technologies that capture critical cardiac data. Solutions like Mobile Cardiac Telemetry (MCT) and extended Holter monitoring have become invaluable tools, helping detect heart issues earlier, enabling personalized care and aligning with the goals of value-based care initiatives.

Providers have typically outsourced ambulatory cardiac monitoring services due to the complexity and resources required for in-house management. But with advances in technology and shifts in reimbursement policies, physicians and other clinicians are rethinking that strategy. Taking these services in-house is an opportunity to improve patient care, streamline processes and create more sustainable operations.

The reimbursement landscape of cardiac monitoring

Reimbursement policies are critical in determining the feasibility of in-house cardiac monitoring. Providers must navigate complex parameters, where reimbursement rates vary depending on the type of monitoring and the payer. MCT and extended Holter monitoring are both effective, but they are reimbursed under distinct Current Procedural Terminology codes, each with different requirements and reimbursement rates.

Traditionally, MCT has been reimbursed at higher rates than extended Holter monitoring due to its ability to provide real-time data and continuous remote monitoring over extended periods. Medicare and private insurers view MCT as a more advanced diagnostic tool, justifying its higher reimbursement rate. On the other hand, extended Holter monitoring, while offering similar diagnostic capabilities over longer time frames, generally comes with lower reimbursement rates.

Extended Holter monitoring has recently gained attention as a cost-effective alternative to MCT, offering similar diagnostic value with fewer administrative demands, such as medical records management or pre-authorization requests. As a result, Medicare is exploring adjustments to MCT reimbursement rates, potentially aligning them more closely with those of extended Holter monitoring — a shift that could have significant financial implications for physicians.

Impact on providers

Medicare has been actively reviewing reimbursement policies for cardiac monitoring services, with a growing focus on long-term cost-effectiveness and enhanced patient outcomes. In 2023, for example, Medicare proposed increasing reimbursement rates for extended Holter monitors, acknowledging their ability to capture comprehensive cardiac data over extended periods — a move that aligns with broader trends aimed at improving both efficiency and quality of care.

These adjustments could require a shift in operational strategy to ensure that practices remain aligned with evolving reimbursement rates and quality standards. By bringing cardiac monitoring technology in-house, practices can maintain greater control over their revenue streams.

Outsourcing cardiac monitoring services can limit this potential, as physicians and other clinicians may miss out on both technical and professional reimbursements. Managing both the equipment and data internally allows practices to capture reimbursement opportunities they might otherwise lose, maximizing both technical and professional reimbursements.

Leveraging scalable solutions for adaption

The success of in-house cardiac monitoring relies heavily on selecting and implementing the right technology. Providers should consider tools that balance clinical effectiveness, ease of use and operational efficiency to meet the growing demand for ambulatory electrocardiogram (ECG) services while supporting clinicians and patients. At the core of any ambulatory monitoring solution is the wearable device, which should deliver reliable data accuracy and extended battery life.

Reusable ECG patches that can monitor patients for multiple days without frequent replacements reduce device waste and ensure continuous data collection. For example, a study comparing a 14-day continuous ECG patch with a traditional 24-hour monitor found that the patch was more effective at detecting irregular heart rhythms. The patch detected issues in 66% of cases, compared with just 9% with the 24-hour monitor.

Beyond just wearable devices, technology integration is key. A streamlined connection to electronic medical record (EMR) systems reduces the need for manual data entry, minimizing human error and ensuring accurate and up-to-date patient information. Whether in a large hospital or a smaller clinic, solutions like multiday wearables and EMR syncing can be tailored to the size and scope of the practice. This adaptability ensures that high-quality care is delivered — regardless of the facility’s size or patient volume.

Enhancing workflow efficiency and regulatory compliance

Bringing cardiac monitoring in-house delivers clear financial and operational advantages. Without relying on third-party vendors, practices can take direct control of scheduling, coordination and communication, creating smoother workflows and reducing unnecessary delays. Solutions like Vivalink’s technology, which supports both MCT and extended Holter monitoring, let practices oversee monitoring and data interpretation themselves.

Integrated solutions also simplify the administrative side. By automating data entry, they save time, cut down on errors and free up staff for more critical tasks. Real-time data transmission ensures quick access to vital information, helping clinicians make timely decisions and interventions. These tools also align with current regulatory standards, making it easier for practices to meet requirements for arrhythmia detection and reporting without added stress.

A recent study on value-based reimbursement highlighted the growing need for scalable technology in health care. For cardiac monitoring, this means adopting solutions that can handle fluctuating patient volumes while supporting long-term efficiency and better patient care. Practices equipped with the right tools are not just meeting today’s needs but are also better prepared to navigate future changes in reimbursement.

Preparing for future policy changes

As Medicare continues to adjust its reimbursement structures, staying ahead of the curve is necessary for physicians. Bringing cardiac monitoring in-house offers a way to navigate these shifts with greater control and stability. By reducing reliance on third-party vendors, practices can streamline operations, improve patient care and mitigate financial uncertainty.

Investing in scalable technology — whether for MCT, extended Holter monitoring or both — addresses immediate needs and prepares providers to adapt to future challenges. These solutions ensure that practices remain aligned with evolving reimbursement models and regulatory standards while delivering consistent and high-quality care. Providers who take proactive steps now will be better equipped to handle industry changes and sustain long-term success.

With more than 26 years of experience in the health care industry, Ethne Nance is the CEO of Pacific Medical Revenue, a company that provides revenue cycle management, compliance consulting, and medical billing services to health care providers. Her extensive professional experience includes being a national speaker and consultant, where she shares her expertise and insights on health care revenue optimization with diverse audiences.