POV | April 12, 2017 | Lou Silverman Not All Telemedicine is Created Equal. The Case for Tele-ICU. A recent study by the Rand Corporation, as reported in Health Affairs, spurred quick reaction among many in the healthcare industry. Some agreed with the conclusions, others disagreed, and a number took exception to the methodology. At Advanced ICU Care we are pleased to see the discourse regarding telemedicine move increasingly into the mainstream. As a leader in the inpatient telemedicine segment, Advanced ICU Care has 10+ years of experience in the field. Our observations are neither theoretical nor hypothetical. Rather, our knowledge is formed through experience with more than a quarter million ICU patients across dozens of unique hospitals and care environments. In over a decade of providing tele-ICU services with hospital partners, Advanced ICU Care has had the opportunity to test and prove the impacts of telemedicine. We currently work with over 65 hospitals in providing technology-enabled acute care, with our initial client hospitals remaining partners 11 years later. We consistently find significantly decreased mortality among critically ill patients at hospitals that have partnered with Advanced ICU Care for tele-ICU care; lives are saved, when measured against expected results based on patient acuity. Similarly, a patient’s length of stay in the ICU is reduced significantly, typically a full day or more. There are other consistent benefits as well – less time spent on a ventilator, shorter overall hospital stays, improved best practice compliance, fewer unnecessary transfusions and in many cases increases in patient volume and case acuity for the hospital. These yield both qualitative benefits – patients return home when they otherwise might not have – and specific and measurable cost avoidance for the hospital, as providing care in the ICU is typically among the highest cost services for the hospital. In sum, tele-ICU consistently yields a proven ROI of 2-6X. Recently, a large hospital system presented us with the opportunity to partner with the ICU in a hospital that it felt had significant room for improvement. In the system’s own analysis, volume improvements and cost reductions combined to yield a 900% return, inclusive of all telemedicine costs. These clinical improvements are found consistently, regardless of whether the partner hospital has intensivist staffing at the bedside. They result from a variety of influences, with tele-ICU consistently offering enhanced staffing, critical care experience, best practices leadership, data-enabled decision making, and a critical care safety net, each of which can be valued and utilized differently by each hospital. It is important to note that the improved clinical outcomes do not result from tele-ICU initiated changes in discharge behavior, however, as decisions to admit or release a patient always remain with the attending physician in the hospital rather than in the hands of the tele-ICU care team. Various industry research has consistently proved these same positive impacts of tele-ICU. In a 2013 study reported in CHEST1, tele-ICU performance evaluated across 56 ICU units reported ICU mortality was reduced 26% and overall hospital mortality dropped by 16%. A 2016 study validated significant positive financial outcomes from tele-ICU care, including increased annual revenue of 46% and direct contribution margin per case of almost 300%.2 Our tele-ICU results and those of others who have measured them have been consistent, with both clinical and financial benefits proved. The adoption of these foundational telemedicine practices should be more quickly expanded to deliver better patient outcomes and improved financial performance for hospitals, as well as to avoid potential negative impacts of the growing shortage of intensivists. Newer telehealth initiatives such as direct-to-consumer care or home health monitoring need to continue to experiment while undergoing appropriate evaluation and iteration. 1 Lilly CM, McLaughlin JM, Zhao H, et al. “A Multi-center Study of ICU Telemedicine Reengineering of Adult Critical Care”, The American College of Chest Physicians, 2013. 2 Lilly CM, Motzkus C, Rincon T, Cody SE, Landry K, Irwin RS, for the UMass Memorial Critical Care Operations Group, ”ICU Telemedicine Program Financial Outcomes, CHEST 2017.