Adding Ancillaries: Holter monitoring

If you have patients who are nervous about skipped heartbeats or who feel flutters in their chests, consider adding a profitable service that will help you look for the cause of the problem. Doctors who use Holter monitors to record patients' heart rhythms, usually over a 24-hour period, have discovered that they can offer this service without a large outlay of cash (if they use a vendor to supply the monitors rather than purchase them) and reap the financial rewards.

"Because I provide this service, my patients don't have to go elsewhere and can be monitored sooner rather than later," says internist Jeffrey M. Kagan of Newington, CT. "The devices are easy to order from a vendor, and this is a good profit center for the practice."

Convenience is also a factor for internist John L. Capps of Gastonia, NC, "Years ago, all our Holter studies were done by local cardiologists. This made sense when they also saw the patient in consultation. However, we order Holter studies for patients who aren't being treated by a cardiologist. Since we review the data and reports, we decided to provide the service through our office."

Equipment

There are two ways to add Holter monitoring to your practice. The first requires an outlay of cash: You purchase a Holter recorder and software package and use it with a computer to generate reports that you interpret. Or you can arrange for a vendor to supply the monitor and patient kits (scrub pad, razor, alcohol prep pads, electrodes, 9- volt battery, and patient diary) to your practice.

To decide whether buying is economical, ask yourself whether you order enough Holter studies during the course of a year. The answer depends on many variables, but as a very rough estimate, figure that an inexpensive system could pay for itself in a year if you do about 25 studies. If your volume doesn't warrant a purchase, or you simply don't want to spend the cash, opt for the outside vendor route.

If you do decide to purchase the equipment yourself, you'll need to order a Holter system and a recorder. Since the reports are run on a computer, you'll also need to make sure the computer you intend to use has the required capacity. The minimum requirements for the IQmark EZ Holter made by Midmark Diagnostics Group are a Windows-based PC with a Pentium-based processor, 64MB of RAM for Windows 2000 or XP, and 500MB of free hard-disk space. Other systems may have other specifications.

If you have an arrangement with a vendor, it will supply the recorders. Analog models record the patient's heartbeat on a cassette tape that you send to the vendor, usually via overnight service. If you use the newer technology digital recorder, a designated person in your practice can feed the data from the recorder into the practice's computer and send it electronically to a central location. Depending on the vendor, the report that's generated will be posted on a website, sent via e-mail, returned by overnight delivery service, mailed, or faxed to you.

Space

Analog recorders are about 4 inches by 6 inches and come with a carrying case. If you're simply storing one or two until needed, you can keep them in a file drawer or cabinet along with cassettes, lead wires and patient kits. If you purchase the units and run your own reports on a computer, you'll need desk space for the computer, as well. Newer digital recorders are the size of a beeper.

Internist John Capps doesn't even keep his recorders in the office. When a patient needs to be monitored, the vendor, Cardiac Monitoring Services of Tustin, CA, sends the equipment to Capps' office in time for the scheduled appointment-overnight, if need be.

All of the physicians we spoke to use existing examination or procedure rooms to apply the leads for the recorders to patients and to remove them as well. The reports are kept in the patient's file.