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Telemedicine-based ICU Care Boosts Outcomes, Saves Millions

An audit of Emory Healthcare's three-year-old eICU program finds that the telemedicine-based ICU platform saved the Atlanta health system $4.6 million in Medicare costs over 15 months, while reducing readmissions and post-discharge care.

Source: ThinkStock

By Eric Wicklund

- Emory Healthcare has saved roughly $4.6 million in Medicare costs by deploying a telemedicine platform in its intensive care unit.

The results come from a three-year audit of the Atlanta-based health system’s eICU program, which has served more than 20,000 patients across five hospitals. The audit, by Abt Associates, also indicated the eICU program reduced discharges to home healthcare, skilled nursing and long-term care facilities and reduced the rate of 60-day inpatient readmissions over a 15-month period.

“These independent findings verify that our innovative approach to addressing a highly variable, complex patient population – those in the critical care unit – improves patient outcomes, allowing them to leave the ICU healthier, thereby reducing the need for patients and their families to have extended rehab stays or be readmitted,” Timothy Buchman, director of Emory’s Critical Care Center, said in a press release.

The health system uses a Royal Philips telemedicine platform to provide critical care services to 136 beds across five hospitals.

The audit, conducted on behalf of the Centers for Medicare & Medicaid Services (CMS), focused on how the health system used a CMS innovation grant to “tackle healthcare challenges with novel approaches and solutions.” The three-year-old eICU program was compared with nine other hospitals in the Atlanta area.

READ MORE: Telemedicine Success Requires an Alignment of Incentives (and Attitudes)

According to the audit, Emory’s eICU program:

  • saw an average reduction of $1,486 in Medicare spending per 60-day episode, yielding a cost savings of $4.6 million over the 15-month comparison period;
  • reduced the rate of discharges to home healthcare by 4.9 percent, while discharges to skilled nursing facilities and long-term care hospitals dropped by 6.9 percent;
  • reduced the rate of 60-day inpatient readmissions by 2.1 percent.

“These findings have shown that increased stability with fewer complications has longitudinal benefits beyond when a patient leaves the ICU,” Manu Varma, business leader for the  Philips Wellcentive and Hospital to Home units, said in the press release. “As health systems transition to value-based care and depend more on population health tools, these long-term benefits to patients are not only reducing readmissions and improving outcomes, but also have the potential to increase hospital ratings and lower the cost of care.”

The audit adds to the growing literature that a telemedicine platform serving the healthcare system’s sickest patients can improve outcomes and save money.

Just last year, UMass Memorial Medical Center reported similar success with its Philips eICU platform in a study published in CHEST.

The UMass study, encompassing more than 51,000 patients across seven adult ICUs and comparing a traditional ICU to the eICU platform, found that the telemedicine platform:

  • improved case volume by 21 percent over traditional models; and
  • improved contribution margins by 376 percent ($37.7 million compared to $7.9 million) due to increased case volume, shorter lengths of stay and higher case revenue relative to direct costs.

READ MORE: The Benefits and Challenges of Telehealth for Specialists

When combined with a logistical center, the study found that a tele-ICU program

  • improved case volume 38 percent over traditional models; and
  • improved contribution margins by 665 percent ($60.6 million compared to $7.9 million).

"The ability of tele-ICU programs to increase case volume and access to high quality critical care while improving margins suggests a strong financial argument for wider adoption of ICU telemedicine by health systems and intensivists," said Craig M. Lilly, director of the UMass Memorial eICU program, a professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School and the study’s lead author. "It has been well documented that properly implemented telehealth programs can have a significant impact on patient outcomes, and this study now supports the financial investment behind it."

More recently, Emory Healthcare tried out a new twist on the eICU model.

Last fall through this spring, the health system partnered with Macquarie University in Sydney, Australia, to create an eICU network that spans the two continents. Emory clinicians were posted at the Australian hospital to cover Emory’s eICU program during nighttime shifts, when its’ daytime Down Under, and on some weekends.

That project put a couple of healthcare theories to the test. One is that the level and quality of care drop during a hospital’s off-hours, when clinicians aren’t at their best or most awake. The second is that off-hours shifts are often staffed by young and less experienced doctors and nurses, those who need the extra hours or don’t have the seniority to avoid them.

READ MORE: How Nighttime Telehealth Services Can Improve Overnight Care

Indeed, studies have shown a sharp drop-off in clinical outcomes for patients treated off-hours, compared to those treated during the day. Conversely, studies have shown that eICU programs improve patient survival rates by some 26 percent over traditional ICU programs, with a 20 percent faster discharge rate.

Buchman, who shepherded that six-month program, should have results of that study soon. 

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