Current status of reimbursement practices for remote monitoring of cardiac implantable electrical devices across Europe

Abstract

Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) is currently proposed as a standard of care for CIEDs follow-up, as recommended by major cardiology societies worldwide. By detecting a series of relevant device and patient-related parameters, RM is a valuable option for early detection of CIEDs' technical issues, as well as changes in parameters related to cardio-respiratory functions. Moreover, RM may allow longer spacing between in-office follow-ups and better organization of in-hospital resources. Despite these potential advantages, resulting in improved patient safety, we are still far from a widespread diffusion of RM across Europe. Reimbursement policies across Europe still show an important heterogeneity and have been considered as an important barrier to full implementation of RM as a standard for the follow-up of all the patients with pacemakers, defibrillators, devices for cardiac resynchronization, or implantable loop recorders. Indeed, in many countries, there are still inertia and unresponsiveness to the request for widespread implementation of RM for CIEDs, although an improvement was found in some countries as compared to years ago, related to the provision of some form of reimbursement. As a matter of fact, the COVID-19 pandemic has promoted an increased use of digital health for connecting physicians to patients, even if digital literacy may be a limit for the widespread implementation of telemedicine. CIEDs have the advantage of making possible RM with an already defined organization and reliable systems for data transmissions that can be easily implemented as a standard of care for present and future cardiology practice.

Implantable Cardioverter-Defibrillators in Poland Compared with other European Countries from the Patient’s Perspective: Insights from the EHRA Patient Survey

“…In this analysis, we observed a huge gap in the implementation of remote monitoring; Polish patients were approximately a third as often controlled with remote monitoring compared with other regions. This could be at least partially explained by significant heterogeneity in reimbursement policies across Europe [ 20 ]. An analysis of the baseline characteristics revealed that over 50% of study participants were enrolled in France, Germany and Spain, countries with wide reimbursement policies.…”

“…An analysis of the baseline characteristics revealed that over 50% of study participants were enrolled in France, Germany and Spain, countries with wide reimbursement policies. Contrary to that, there is a lack of remote monitoring reimbursement in Poland, which is one of the primary barriers for its wider implementation [ 20 , 21 ]. Of note, almost a quarter of Polish patients wanted to learn more about the remote monitoring of an ICD.…”

The reuse of cardiac pacemakers and defibrillators: A convoluted history in an era of global health

“…Such remote monitoring will involve privacy matters and cybersecurity concerns 75 . Reimbursement considerations of remote monitoring varies greatly in developed countries, 76 and will likely lead to new costs to support reuse of CIEDs in LMICs.…”

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

“…Third, there is significant worldwide heterogeneity in the reimbursement for RM 86,189,195 . In Europe, many clinics receive no reimbursement for RM, and this has been identified as a major barrier to the use and expansion of RM 86,195 .…”

“…86,189,195 In Europe, many clinics receive no reimbursement for RM, and this has been identified as a major barrier to the use and expansion of RM. 86,195 Uptake of RM has slowed in parts of the Asia-Pacific region, with a lack of reimbursement identified as a barrier in many locales. 189 Finally, a larger shift may be needed in how we think about RM of CIEDs.…”