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Telemedicine Study Makes a Financial Case for eICUs

The UMass Memorial Medical Center study found that telemedicine-enabled ICUs, or eICUs, can improve case volume and pay for their capital costs in three months.

By Eric Wicklund

- Telemedicine access in a hospital’s ICU can improve case volume, save millions of dollars and pay for its own capital costs within three months, according to a new study.

Conducted by Craig M. Lilly, MD, director of the eICU program at UMass Memorial Medical Center and using Philips tlemedicine technology, the study found that a tele-ICU or eICU program with centralized bed management control can increase case volume by as much as 44 percent and improve contribution margins by almost $53 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," says Lilly, a professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School, in a press release. "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."

Lilly led a project that analyzed more than 51,000 patients across seven adult ICUs on two campuses of an 834-bed academic medical center in Massachusetts. It compared a traditional ICU with UMass Memorial’s Philips eICU program, as well as a tele-ICU program with a logistical center to improve bed use and standardize care.

The study, while will appear in the February 2017 issue of CHEST, compared case volume and contribution margins, which are derived from total revenue minus direct costs.

READ MORE: Telemedicine Study Cites Tele-ICU's Positive Impact on Patients

According to the study, the UMass Memorial Medical center’s tele-ICU program

  • 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.

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).

"An ICU bed costs approximately $2 million to build, and this study demonstrates a significant increase in case volume by better utilizing existing resources," Tom Zajac, Philips’ chief executive officer and business leader for population health management, said in the press release. "This shift enables care for expanding populations without having to build and staff additional ICU beds, thus helping hospitals thrive in a value-based care environment."

Telemedicine programs have often looked to the ICU – the most expensive and intensive department in the hospital – to prove their mettle in the healthcare setting but establishing a sustainable program with a solid ROI hasn’t been easy.

One of the acknowledged leaders in the eICU ecosystem is St. Louis-based Mercy Health, which opened the nation’s first all-digital “hospital without beds” in late 2015. Mercy Virtual now sits at the middle of a hub-and-spoke telemedicine network that includes the University of North Carolina Health Care system and Penn State Health’s Milton S. Hershey Medical Center, as well as its own hospitals and clinics in six states.

READ MORE: VT Health System Offers Tele-ICU, Specialized Telemedicine Care

"Virtual care will positively impact our quality, cost and the patient experience across our health system and beyond because it will allow us to identify and meet patients' needs earlier," Craig Hillemeier, MD, Penn State Health’s CEO, said when the partnership was announced with Mercy Virtual last May. "Having this 'second set of eyes' on our most ill and injured patients will identify and meet patients' needs faster, often presenting simpler and less intensive solutions. In the long term, this type of partnership can help address the nursing and physician specialist shortages across the country."

Through its SafeWatch Critical Care program, the 32 ICUs in the six-state, 32-hospital Mercy Health system have seen a 35 percent decrease in patient length of stay and 30 percent fewer deaths, resulting in $40 million to $50 million in savings and, as Mercy Virtual President Randall S. Moore, MD, puts it, “900 people going home who were predicted to die.”

Emory Healthcare, which provides telemedicine services to several small hospitals in and around Georgia, might be the current record-holder for the longest eICU program, in terms of distance. The Atlanta-based health system is currently piloting a program that places its clinicians at Macquarie University in Sydney, Australia, where they provide eICU services during nights and weekends.

“There are very few people who are truly nocturnal,” Timothy G. Buchman, MD, PhD, director of the Emory Critical Care Center and chief of the health systems critical care service, who developed and launched the ongoing six-month project, told mHealthIntelligence.com earlier this year. More importantly, he said, ICU staff need to be top-notch and fully awake because they’re dealing with the sickest of the sick, and the most complicated patients in a hospital.

The eICU concept also has support from those most familiar with it. According to a survey by Chicago-based Rush University Medical Center’s Center for Clinical Research, more than 60 percent of ICU nurses support the telemedicine platform.

READ MORE: Intermountain's Critical Take on Telehealth

“Tele-ICUs improve patient care by providing an enhanced monitoring capability to detect potential patient compromise earlier,” Ruth Kleinpell, RN, PhD, APRN-BC, CCRN, the center’s and the study’s lead author, said.  They also “help promote collaborative care by using telehealth nursing and physician staff and on-site clinical staff to collectively manage patient care issues, as well as to enhance communications with patients and family members.”

That study also noted that eICUs can be hampered by negative opinions as much as financial difficulties. Of the barriers cited, 45 percent of those surveyed listed attitudes of ICU staff members as the strongest deterrent to tele-ICUs, and more than 40 percent said tele-ICUs were “perceived as interference.” Roughly 23 percent of those surveyed also listed attitudes of tele-ICU staff and “collegial respect” as barriers.

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