Return on Investment: An Economic Impact Analysis of Coastal Fertility Specialists  Partnering with Cycle Clarity

Executive Summary

Fertility practices face significant financial constraints, operational challenges, and clinical inefficiencies. Cycle Clarity solved these challenges at Coastal Fertility Specialists while simultaneously improving the patient experience and increasing net operating income. An analysis was performed to evaluate the realized and perceived value delivered to Coastal Fertility Specialists when comparing clinical operations and costs, before and after implementation of Cycle Clarity. This includes the value of time saved directly associated with Cycle Clarity monitoring ultrasounds, downstream clinical decision making tools, embryology workload balancing, and increased patient volume with reduced overhead.

 

Over the 3 year period of using Cycle Clarity at Coastal Fertility Specialists:

• Coastal Fertility Specialists received a 212% annual return on it’s investment using Cycle Clarity
  • Coastal Fertility Specialists experienced a 58% growth in ART cycles with only a 4.7% increase in ultrasonographer staffing costs
  • The sonographer expense per ART cycle performed decreased 51% from $112.69 per cycle to $74.69.
• Coastal Fertility Specialists collected on average $119.20 per 3D insurance claim submitted
• Ten additional patients underwent fertility treatment over 6 months utilizing Cycle Clarity Connections that Coastal Fertility Specialists would not have had access to otherwise adding approximately $45,000 in net revenue.
• Embryology outcomes improved including the number of mature oocytes per retrieval, blastocyst conversion rates and pregnancy rates per new patient visit.
• Increased patient satisfaction through:
  • Decreased wait times and decreased ultrasound probe contact time
  • Immediate patient delivery of ultrasound results
  • Patient Clarity patient education platform 

Introduction

Cycle Clarity is a Fertility Clinical Management Platform that foundationally evolves around improving patients’ experience and providing clinical efficiencies. The Flagship product, Follicle Clarity, is an FDA cleared software platform that starts with automatically detecting and measuring follicles during an assisted reproduction stimulation cycle, via a 3D tranvaginal ovarian sweep. These exams have a probe contact time of less than two minutes, and results are rendered in less than 60 seconds.. Reducing probe contact time is a major point of emphasis in decreasing patient discomfort and increasing overall patient satisfaction while maintaining a high level of care. Through the 3D ovarian sweep, our AI follicle annotations consistently identify the maximum diameter of each follicle, ensuring accurate and standardized measurements. This process guarantees that follicles are measured at their true largest diameter, independent of the sonographer conducting the exam. Annotated videos show up in the portal for clinical verification and all follicular data can be transmitted directly to an EMR solution. Through simplifying the monitoring process, Cycle Clarity reduces workforce strain and staffing constraints by giving the ability for nurses and medical assistants to perform the ovarian monitoring ultrasound with the accuracy expected by a Reproductive Endocrinologist. 

With Cycle Clarity Connections, outside patient monitoring becomes “inside monitoring” by partnering with collaborative providers, such as an OB/GYN, Imaging Center, or MFM, etc. Cycle Clarity Connections allows for the acquisition and measurement accuracy of follicles while providing complete imaging of the uterus and ovaries for your clinical team to review. Cycle Clarity Connections ultrasounds and hormone results are completely integrated within the system allowing patients scanned by any collaborative provider to send scans directly into the Cycle Clarity portal and your EMR.

Cycle Clarity then aggregates all monitoring data, inside and out, for each patient and provides unique and accurate insights to assist with embryology workload and resourcing that can be customized by each center. These tools allow reproductive endocrinologists to make the best clinical decisions for patients without over-constraining the embryology lab to achieve the best results. 

In keeping with patient centric products, the Cycle Clarity platform houses numerous patient friendly staffing efficiencies including:

The ability to send follicular reports directly to the patient email – keeping them engaged in their cycle and reducing physician and nursing time.  

The ability to share ovarian and uterine ultrasounds with external physicians for surgical consultations and second opinions, minimizing additional repeat ultrasounds.  

The ability to organize and assign center specific educational videos to your patients through Patient Clarity.  Patient Clarity is a video education platform that allows the clinical team to track viewing progress of personalized video content sent directly to the patient, created by your own team. The center specific video content provides information to patients creating the confidence they need in their own protocols and processes, aligning expectations to deliver the best care. 

Cycle Clarity, a complete fertility clinic management solution, is focused on the patient experience and clinical efficiencies. Cycle Clarity is a tool that helps clinics maximize efficiency, patient satisfaction, and increase margins by allowing for a top-of-licensed care model and reducing redundant services, and most importantly, allows your clinic to serve more patients without increasing staffing overhead. 

Providing Solutions, Realized Value Assessed

Prior to implementing Cycle Clarity, Coastal Fertility Specialists located in Charleston, South Carolina, was performing 1,261 ART Cycles across 5 locations in two states in 2020. At the time they had 6 staff members providing ultrasound services consisting of sonographers, nurses, and nurse practitioners that were responsible for all monitoring ultrasound appointments, along with weekend per diem sonographers as needed. With the implementation of Cycle Clarity, and its standardized measurement platform, Coastal Fertility Specialists was able to cross train additional staff members in ultrasound, decreasing significantly the ultrasound staffing strain across the network. Through this cross training, Coastal Fertility Specialists doubled the number of trained staff members providing ultrasound services, consisting of licensed ultrasonographers, medical assistants, nurses, and nurse practitioners; with the majority of ultrasounds now being conducted by medical assistants. The increased sonographer staffing and flexibility improved clinical efficiencies while the clinic saw 58% growth in ART cycles over the three year period, totaling 1992 ART cycles in 2023. This growth margin was accomplished with only a 4.7% increase in ultrasound services overhead surrounding those monitoring visits. The sonographer expense per ART cycle performed decreased 51% from $112.69 per cycle to $74.69, Figure 1. Ultimately, Cycle Clarity allowed Coastal Fertility Specialists to eliminate staffing constraints by decreasing the cost of sonography services per ART cycle while increasing clinical volume growth and simultaneously improving patient satisfaction.

Figure 1: 

Insurance Reimbursement:

In addition, the use of Cycle Clarity allowed Coastal Fertility to increase revenue $24,609 annually through increased insurance collections. The use of 3D technology that allows for Cycle Clarity to acquire a volume sweep of the ovaries can be reimbursed with a specific add-on CPT Code that saw on average 53% collections and roughly $119.20 per collection against all patients filed against, noted in Table 1. 

Table 1:

Percent of Claims Collected	53%
Average Reimbursement per Claim Submitted	$119.20
Total Annual Collections	$24,609

 

Embryology Outcomes:

With FDA cleared Cycle Clarity implemented, Coastal Fertility Specialists opted for all stimulated cycle follicle measurements to be done using Cycle Clarity to drive consistency and limit interobserver variability. Coastal Fertility Specialists’ live birth rate per egg retrieval in women less than 35 years of age was 62% in 2019, before implementation of Cycle Clarity, and increased to 71.9% in 2021, the most recent year with finalized reporting. During the same period of time the number of mature oocytes per retrieval increased from 11.9 to 12.2 and the blastocyst utilization rate increased from 53% to 57%. 

Coastal Fertility Specialists physicians and embryologists feel Cycle Clarity encouraged them to “go longer” on the ovarian stimulations with the average trigger day increasing to 12.5 from 12 which may have contributed to the increased number of mature oocytes. There were no major laboratory protocol, media, or hardware changes in the Coastal Fertility Specialists laboratory during this time period. Pregnancy rates are certainly multifactorial. The improved embryology outcomes and pregnancy rates are not attributed to Cycle Clarity alone, however, the standardization of follicular measurements along with clinical decision making tools and optimal trigger predictions based on follicle size can certainly be noted as a beneficial change. 

Embryology workload balancing is available through Cycle Clarity Lab Clarity providing real time workload calculations for the physicians making trigger decisions. These calculations start at the follicular level accounting for all follicles measured by Cycle Clarity on any given day including both inside and outside monitoring (Cycle Clarity Connections). Using data from your EMR, patient specific details of ICSI, blastocyst conversion rates and embryo biopsy are then utilized to predict workload over the upcoming week. Acknowledging that patient specific trigger decisions can clinically vary by one or two days, Lab Clarity can provide workload calculations in real time so physicians have another data point for trigger decisions. Through the use of Lab Clarity, Coastal Fertility Specialists physicians were able to decrease workload variability in the embryology laboratory.

Ultrasound Staffing:

Coastal Fertility Specialists did not terminate any sonographers during the implementation of Cycle Clarity. Through normal staff recruitment to compensate for growth and staff attrition, Coastal Fertility Specialists benefited from the cross training of its Medical Assistants allowing significant staffing flexibility improving its practice operations. Medical assistants can assist with every aspect of the monitoring visit for fertility clinics, including but not limited to: ultrasounds, vitals, blood draw, chaperoning, assistance in the OR and other essentially organizational activities. Licensed sonographers are needed and utilized by Coastal Fertility Specialists to focus on more advanced diagnostic ultrasounds for patients with anatomic imaging challenges along with staff training, equipment adjustments and troubleshooting. Cycle Clarity is an operational tool to drive a top-of-license model within the fertility setting. 

Cycle Clarity Connections:

Furthermore, Cycle Clarity Connections has given the ability and confidence for Coastal Fertility Specialists to serve more patients at a distance. Cycle Clarity Connections allows for any collaborative provider with a 3D compatible system to acquire ovarian sweeps, be annotated with Cycle Clarity and then directed to the Coastal Fertility Specialist MyCycleClarity portal, where physicians can review patient scans from top-to-bottom with accurate measurements. In the first six months of Cycle Clarity Connections being available, Coastal Fertility Specialists has been able to partner with multiple collaborative providers to serve 10 patients at their local OB/GYN, with more cycle starts planned. This capability has increased the effective footprint of Coastal Fertility Specialists without any additional brick-and-mortar investment and more importantly, given them the ability to serve patients locally until their treatment procedure. This reduces travel, stress, and cost for patients who face geographical barriers. 

Perceived Value 

Cycle Clarity is an operational tool that has additional perceived value in pertaining to workforce burnout, patient satisfaction, and patient education. 

A patient satisfaction study was conducted at Coastal Fertility Specialist by Cycle Clarity. All patients preferred the quicker Cycle Clarity exam as opposed to traditional manual measurements saving patients time and discomfort. In addition, 98% of patients felt that artificial intelligence measuring follicles is a benefit to their fertility care. Lastly, all patients were highly satisfied knowing that their physician could review their ovarian scans at any time. 

In addition, the Patient Clarity video platform has reduced significant strain on nursing staff both during business hours and during after call hours. The videos are assigned to patients and can be watched as many times as the patient would like. With Patient Clarity the video completion rate was 76% as opposed to using other means like youtube or vimeo which saw patient completion rates of less than 60%. The top ten videos Coastal Fertility Specialist created and assigned using Patient Clarity are noted below:  

The top videos: 

1. Gonal F Injection Instruction 
2. Vaginal Bleeding During Pregnancy
3. I’m Pregnant, Now What 
4. Progesterone in Oil Injections
5. Low Dose HCG Injection Instructions
6. Follistim Injection Instructions
7. Egg Retrieval
8. Ovarian Stimulation with Intrauterine Insemination
9. Antagonist Injections
10. Post Transfer Instructions

The assigned videos, along with the completion rate and watch rate has reduced the “on-call” volume by 18% and the time per call by 32%. Patients frequently say they watched each video several times for reassurance, especially the Vaginal Bleeding During Pregnancy video. These time savings are tangible and are further reflected in the patient satisfaction study.  

Conclusion 

In conclusion, Cycle Clarity is a clinical management platform which gives clinics and networks the ability to elevate the patient experience, increase clinical efficiency, increase gross revenue and increase profit margins. Utilizing a top-of-license model decreases staffing dependencies, allowing for the reduction in overhead cost associated with clinical patient care. Additional data analytics and clinical efficiency allows for provider operational units to be optimized to achieve high level care at patient volumes that will drive profitability and democratize fertility care through the use of Cycle Clarity, your paramount technology partner. Cycle Clarity delivered a $68,215 improvement in the Net Profit to Coastal Fertility after an annual Cycle Clarity cost of $32,100, yielding 212% ROI surrounding monitoring services.

References available on request.

Cycle Clarity, LLC

Mount Pleasant, SC

843-883-6200

www.cycleclarity.com

 

Data provided by:

Coastal Fertility Specialists

Mrs. Isabel Bryan

Executive Director