ELECTROPHYSIOLOGY SERVICES

The Challenges of Developing Comprehensive Electrophysiology Services

The field of Electrophysiology (EP) has expanded and matured over the past several years.  EP diagnostic testing for arrhythmia treatment and ablation for SVT or VT has evolved rapidly to include the diagnosis and treatment of atrial fibrillation (AF) as well.  Advanced techniques in electrophysiology today also include contact force-sensing ablation catheters that can improve the outcomes in AF ablation; the Watchman device (Boston Scientific), FDA approved in March 2015 as a substitute for anticoagulation therapy; leadless pacemakers (Nanostim, St. Jude Medical, not currently FDA approved and Micra, Medtronic), currently FDA approved; and advanced CRT-D (cardiac resynchronization therapy-defibrillator) devices shown to be more effective in treating cardiac rhythm/heart failure (CRHF) patients than past technologies.  The rapid growth of these EP techniques creates a challenge for programs attempting to stay abreast of clinical trends in the field.

EP services, if offered locally, tend to stay local.  Depending on local market circumstances, EP services can represent both a large opportunity for EP sub-service line growth, as well as an opportunity to better serve the community.  The comprehensive heart program of the future will have comprehensive EP as one of the cornerstones of its clinical offerings.

How to Succeed in the Electrophysiology Market

For those hospitals not yet focusing on EP, it is prudent to incorporate this issue into their mid and longer range strategic planning.  Hospitals seeking to add or expand their EP capabilities should consider the following:

• Profitability is generally stable and reasonably good.  CMS recently released the Medicare Inpatient Medicare Severity Diagnosis Related Group (MS-DRG) base payment for CRHF implants and ablations.
• While inpatient EP services will continue to shift towards outpatient settings, outpatient EP is expected to grow.  This growth will occur not just because of the inpatient-to-outpatient shift, but also because of increasing demand for outpatient EP services, like ICDs, CRTs, and ablation procedures.
• A highly qualified and board-certified electrophysiologist is virtually mandatory to lead a high quality program.

An Electrophysiology Planning Team, including electrophysiologists and other cardiac subspecialties along with service line administration, should be convened to establish goals, targets for program growth, and development timelines.  Once the general direction of development is outlined, specific and detailed analysis and planning can begin.

How CFA Can Help

CFA provides experienced assistance to address issues of:

• Strategy – EP’s potential impact on overall program positioning and long term growth/success; relationship to the organization’s strategic plan; and implications related to population health management, bundling, and episode-of-care management
• Market positioning – competitor analysis; market trends, and impact on other services
• Financial implications – financial feasibility, including volume projections, capital investment, operational budgeting, potential spin-off volume, ROI, NPV, cash flow, IRR
• Facility development – architectural and design/development assistance pertaining to specialized EP cath lab (including location, functionality, layout) and facility impact on other cardiac services
• Medical Staff implications – physician leadership, participation and support; internal politics; assessment of needed specialists, recruitment needs, and recruiting assistance

Operational implications – cross-training of cath lab staff; cross-coverage; recruitment; anesthesia coverage