On Saturday April 10, 2021, Medicare Administrative Contractor (MAC) Novitas Solutions, Inc. published new reimbursement rates for the Category I Current Procedural Terminology (CPT) Codes for long-term continuous ECG monitoring - codes that are used to reimburse the Zio® XT service for Fee For Service (FFS) Medicare patients. These rates are a 63% to 67% reduction in the prevailing $311 rate Novitas has reimbursed since 2016 and fall below the actual cost we incur to provide the service.
I want to take this opportunity to reinforce our commitment to patients. Clinical evidence has shown, time and again, that long-term continuous ECG monitoring is clinically superior to Holter monitoring. Long-term monitoring delivers significantly higher diagnostic yield (96.6% vs. Holter monitors’ 24%)1, 2 more accurate and timely diagnosis for patients, and a reduction in overall health care resource utilization3. This recent reimbursement decision stands in conflict with the principles of value-based medicine and creates a risk that arrhythmia diagnosis will regress to a time when patients were forced to live with indeterminate results and poor outcomes – cycling in and out of health systems without a clear path to treatment.
On Monday April 12, I made comments to investors about our need to re-examine the ability to provide the Zio XT service for FFS Medicare patients at these new rates. To be clear:
We are currently making no changes to our service level for FFS Medicare patients. Additionally, there is no change for Zio AT patients or Zio XT patients on Medicare Advantage plans.
Our goal is to ensure that all patients who need the Zio service can access it. During this time, we remain hyper-focused on working with Novitas, other MACs, and the Centers for Medicare and Medicaid Services to develop solutions to enable sustainable access to this important service for all Medicare patients. We remain steadfast in our desire to achieve an outcome that is in the best interest of patients and their ability to access quality care.
My commitment to you as our valued partners is to remain in touch as this process unfolds and to partner with you to provide reasonable and viable options that continue to put your patients first. We take our responsibility to patients and care providers very seriously. We know that we share a common goal with Novitas of improving the standard of care for Medicare. With an unwavering focus on patients, together we can continue to improve the standard of cardiac care.
President and CEO
1 Data on file. iRhythm® Technologies, Inc. 2020
2 Tsang, J.P., et al. Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors. Medical Devices: Evidence and Research, 2014.
3 Waalen, J., et al. Healthcare resource utilization following ECG sensor patch screening for atrial fibrillation. Heart Rhythm O2, 2020.