They all play in an incredibly diverse market: ambulatory ECG monitoring . The market is diverse in more ways than one:

  • Many kinds of patients are prescribed these devices to provide information about their heart rhythm. The largest groups are atrial fibrillation patients, syncope (fainting) patients, and increasingly cryptogenic ischemic stroke survivors. The data is used to diagnose or guide therapy, whether it be starting new medication or assessing the efficacy of a cardiac ablation procedure
  • Several types of physicians prescribe these devices from electrophysiologists to primary care
  • There are four business models at play:
    • Insourcing: companies like GE and Philips sell ambulatory ECG monitoring device to providers as pieces of capital equipment. The provider then owns the equipment and recycles it among its patient pool
    • Outsourcing: service companies like BioTelemetry enter contracts with providers to provide monitoring. Service companies provide the equipment, handle the technical aspects of data transmission and clean up the data for physician analysis. In this model the reimbursement is split between the provider and the service company. Providers outsource despite the loss in revenue because it reduces expenses and the headache of dealing with payers. This market segment is home to dozens of firms, most of which focus on providers in their geographic area. For example A1 Heart Monitoring is active in the New York City area
    • Hospital consumable: implantable loop recorders, one of the main reasons why Medtronic’s cardiac rhythm management business is growing, are bought like any other hospital therapeutic device
    • Out-of-pocket: AliveCor’s smartphone enabled ECG recording device is the darling of electrophysiologists. For $99 anyone can own the credit-card sized sensor that wirelessly connects to a smartphone or tablet to provide ECG tracings. Physicians often encourage their patients to buy one on their own and send them tracings when they feel a symptom
  • The variety of device design is wide in this market: there are old school Holter monitors that use electrode leads that adhere to your chest and connect to a pager-like recorder with cables. Newer devices are miniaturized into palm-sized patches that are stuck on your chest for a few days. Information can be transmitted in real time, this can be done in an old fashioned method where the patient holds the recorder’s speaker to a telephone that’s dialed to a monitoring hotline. Newer devices are connected to cellular networks, but this service has faced reimbursement struggles

DRG will be publishing an all new report this fall: US Ambulatory ECG Monitoring. It will provide quantitative insight on patient populations prescribed these monitoring devices, the types of monitoring used, outsourcing vs insourcing revenues, and market shares. Discover how your company fits into this diverse market and what opportunities – or threats – await you.

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