What EP leaders can learn from their vascular colleagues

Our takeaways from HRS 2014

Rory Lubner, Service Line Strategy Advisor

As evidenced by this year’s Heart Rhythm Society (HRS) Scientific Sessions, electrophysiology (EP) continues to captivate the attention of strategic planners and hospital executives nationwide. Until recently, the EP business has largely been earmarked for the most progressive institutions that have the clinical expertise and costly capital infrastructure needed to support such services. 

However, as the EP patient population outpaces program adoption, hospital leaders increasingly view this untapped market as an opportunity for growth and differentiation.

That said, EP program development is not without its challenges. This resource-intensive, often multi-morbid patient base demands strong cost management and multidisciplinary care coordination. With many forces shaping the EP landscape, hospital leaders should turn to lessons learned from an older, yet similarly evolved cardiovascular (CV) business—vascular services—in order to get it right.

While vascular and EP services have limited clinical overlap, both offer high growth opportunities with projected five-year national growth rates of 16% and 15%, respectively. And, as the EP business grows and matures, hospital leaders can learn from vascular’s metamorphosis into a CV program staple.

Covered in-depth in our upcoming “Build an Integrated EP Program” teleconference, below we provide three vascular "lessons learned" that may shape future EP program strategy. 

1. Latent patient populations require well-executed screening

Both vascular and EP patient populations contain significant latent demand due to the asymptomatic, but progressive nature of these diseases.  In order to effectively convert disease prevalence into tangible patient volumes, EP leaders must actively screen and target these patients within the community. As a result, successful EP programs look to vascular to best develop comprehensive screening programs and triage patients effectively. Specifically, CV leaders establish atrial fibrillation (AF) screening programs both as an education tool and a means to identify and capture patients that may need a device or ablation procedure in the future.

EP leaders interested in developing AF screening programs use home-grown approaches to patient screening and tracking due to the absence of a comprehensive national screening database. As vascular leaders know all too well, this approach typically requires targeting high-risk, underserved geographic areas to ensure programs are drawing more than just the “worried well.” 

Related: Your next cardiovascular strategy presentation is ready

2. Ever-evolving technologies challenge cost containment

From the subcutaneous defibrillator to advances in cryoablation and hybrid ablation highlighted at this year’s HRS conference, EP program leaders are tasked with navigating through numerous device innovations – much like the ever-evolving vascular device landscape – to find the most cost-effective technologies without compromising high-quality outcomes. As such, both programs face high device costs which erode potentially profitable margins, especially for favorably reimbursed EP implantable procedures.

To ensure profitable per case financials, successful vascular programs emphasize the following key steps to strong device cost containment:

  • Establish an internal technology taskforce to evaluate pipeline technologies and potential future investments
  • Engage physicians in major technology selection decisions to secure strong support for devices and create financial transparency
  • Use system-wide approach and leverage vendor relationships when adopting technologies to reduce device costs

Hospital executives can apply these same lessons to EP in order to mitigate future cost management challenges and ensure future financial sustainability.

Related: Build an Integrated EP Program

3. Outpatient shift necessitates strong clinic infrastructure

Lastly, as technologies advance, both EP and vascular businesses will continue to shift outpatient. While this lower cost environment expands access to care, this outpatient opportunity demands strong ambulatory infrastructure. To develop this ambulatory presence, EP programs, much like their vascular counterparts, establish regionalized satellite clinics to siphon patient volumes back to the hospital.

Given that device patients require regular monitoring and recalibration, EP clinics focus on electronic evaluations and device maintenance to round out the care continuum. Within these clinics, programs emphasize top of license care, using advanced practitioners to monitor device patients and provide comprehensive follow-up. Moreover, as device integration with remote monitoring platforms improves, telemonitoring options for EP patients will likely remain at the forefront of outpatient EP strategy.

Going forward, shared learning between CV services will be crucial to support the growing EP patient population. As the EP business matures, program leaders should push to integrate across cardiac services and continue to learn from other services to address these resource-intensive patients’ needs and prepare for future growth. 

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