Impact of telemedicine in the high-stakes, high-cost ICU
November 16, 2016
By Lou Silverman
The disruption and evolution of the U.S. health care system toward value-based care continues to drive opportunities for innovation and creative partnerships. Strategic partnering has always been important to how hospitals function, but now, more than ever, specialized service providers are supporting new models of care delivery that demonstrate improvements in quality, outcomes, cost and revenue, and improved job satisfaction for nursing staff and physicians. Telemedicine is emerging as an important example of a technology-enabled service that can achieve the seemingly at-odds objectives of elevating care while improving financial efficiency.
Recent data and real-world examples suggest that even in a high-stakes, high-cost area of the hospital, the ICU, telemedicine services are having a positive impact. The ICU usually represents a disproportionate share of a hospital’s total operating costs. On average, ICUs account for only about 10 percent of beds, but approximately 30 percent of costs. ICU leaders are expected to take steps to achieve 24/7 intensivist oversight, optimize processes and elevate the standard of care in a way that not only improves patient outcomes, but also achieves cost savings through fewer costly complications and reduced length of stay (LOS). This push to continually improve the quality of care in a department that is considered the key escalation point within the hospital, while doing so in a fiscally responsible manner, forces hospitals and health systems to evaluate and re-engineer their ICU delivery models.
Telehealth technology is emerging that can support models that can have dramatic impact, such as reducing ICU mortality 30 to 40 percent. These results are achieved through a continual collaborative 24 x 7 x 365 care tele-ICU model that connects bedside care providers and systems with intensivists and critical care nurses working in a tele-ICU care center. This highly engaged approach operates around the clock with a seamless interface to hospital systems including the electronic health record, pharmacy and bedside monitors, to ensure that a constant stream of patient data is available to the tele-ICU team.
This high level of connectivity enables an ongoing clinical partnership to be created in which informed, remote care teams co-manage patient care 24 hours a day. In addition, the tele-ICU data flow enables information aggregation and multi-level reporting of performance metrics. Rather than simply being reactive to inbound requests from the bedside team, tele-ICU clinicians can leverage technology to more rapidly detect adverse physiologic trends and initiate recommended or required care procedures, all of which can improve outcomes and avoid adverse events.
Due to the high acuity and complexity of patients in an ICU, high-quality care, patient outcomes and financial health are strongly correlated. At an average variable cost of $1,200 per patient per ICU day, for example, reducing LOS will have a significant impact not only on the ICUs, but also, ultimately, on the hospital’s financial performance. In collaboration with hospitals across the country, Advanced ICU Care is collecting real-world data that demonstrate the value of the continuous tele-ICU model.
Analysis of data across 55,000 patients and more than 60 hospitals for 2015 demonstrates the positive impact of tele-ICU services. In this inclusive review, engagement of tele-ICU services enabled the reduction of ICU mortality rates by 34 percent, saved more than 1,400 lives and reduced the typical LOS for a patient in the ICU by more than a full day when compared to expected outcomes. Aggregated, the savings achieved from a reduction in ICU LOS alone in these 60 hospitals was in excess of $65 million.
In one illustrative case, in the first year of implementing a 24-hour, collaborative tele-ICU program, a hospital in Arizona reduced ICU LOS by 21 percent. The elevated care provided in the ICU and improved LOS contributed to a 31 percent reduction in overall hospital LOS and resulted in $2.3 million in savings for the hospital. When looking at all elements of a multi-faceted ROI analysis, this particular hospital calculated a 9x return on its deployment of tele-ICU services.
More broadly, a typical ICU program will yield material clinical implementation of, and adherence to, best practices and established standards of care. In addition, a well-structured tele-ICU program will also yield significant improvement in the ICU mortality rate and ICU length of stay. ICU CMI and patient volume are often positively impacted. Ventilator days typically drop significantly. A long list of other clinical and financial indicators also typically trend advantageously.
Medical initiatives that are focused only on cost-cutting are typically important, but very challenging. The evidence continues to show that a telemedicine approach to the ICU yields significant improvements in clinical outcomes that are critical to hospital CMOs, in the context of a strong, ROI-driven business use case, benefiting patients, their families, the bedside teams that serve them and the hospitals that form the backbone of our health care delivery system.
About the author: Lou Silverman is the CEO of Advanced ICU Care. He has a 15-year record as a CEO in health care technology and services companies. Silverman also serves on the board of directors for a variety of health care-related companies, both public and private.
The disruption and evolution of the U.S. health care system toward value-based care continues to drive opportunities for innovation and creative partnerships. Strategic partnering has always been important to how hospitals function, but now, more than ever, specialized service providers are supporting new models of care delivery that demonstrate improvements in quality, outcomes, cost and revenue, and improved job satisfaction for nursing staff and physicians. Telemedicine is emerging as an important example of a technology-enabled service that can achieve the seemingly at-odds objectives of elevating care while improving financial efficiency.
Recent data and real-world examples suggest that even in a high-stakes, high-cost area of the hospital, the ICU, telemedicine services are having a positive impact. The ICU usually represents a disproportionate share of a hospital’s total operating costs. On average, ICUs account for only about 10 percent of beds, but approximately 30 percent of costs. ICU leaders are expected to take steps to achieve 24/7 intensivist oversight, optimize processes and elevate the standard of care in a way that not only improves patient outcomes, but also achieves cost savings through fewer costly complications and reduced length of stay (LOS). This push to continually improve the quality of care in a department that is considered the key escalation point within the hospital, while doing so in a fiscally responsible manner, forces hospitals and health systems to evaluate and re-engineer their ICU delivery models.
Telehealth technology is emerging that can support models that can have dramatic impact, such as reducing ICU mortality 30 to 40 percent. These results are achieved through a continual collaborative 24 x 7 x 365 care tele-ICU model that connects bedside care providers and systems with intensivists and critical care nurses working in a tele-ICU care center. This highly engaged approach operates around the clock with a seamless interface to hospital systems including the electronic health record, pharmacy and bedside monitors, to ensure that a constant stream of patient data is available to the tele-ICU team.
This high level of connectivity enables an ongoing clinical partnership to be created in which informed, remote care teams co-manage patient care 24 hours a day. In addition, the tele-ICU data flow enables information aggregation and multi-level reporting of performance metrics. Rather than simply being reactive to inbound requests from the bedside team, tele-ICU clinicians can leverage technology to more rapidly detect adverse physiologic trends and initiate recommended or required care procedures, all of which can improve outcomes and avoid adverse events.
Due to the high acuity and complexity of patients in an ICU, high-quality care, patient outcomes and financial health are strongly correlated. At an average variable cost of $1,200 per patient per ICU day, for example, reducing LOS will have a significant impact not only on the ICUs, but also, ultimately, on the hospital’s financial performance. In collaboration with hospitals across the country, Advanced ICU Care is collecting real-world data that demonstrate the value of the continuous tele-ICU model.
Analysis of data across 55,000 patients and more than 60 hospitals for 2015 demonstrates the positive impact of tele-ICU services. In this inclusive review, engagement of tele-ICU services enabled the reduction of ICU mortality rates by 34 percent, saved more than 1,400 lives and reduced the typical LOS for a patient in the ICU by more than a full day when compared to expected outcomes. Aggregated, the savings achieved from a reduction in ICU LOS alone in these 60 hospitals was in excess of $65 million.
In one illustrative case, in the first year of implementing a 24-hour, collaborative tele-ICU program, a hospital in Arizona reduced ICU LOS by 21 percent. The elevated care provided in the ICU and improved LOS contributed to a 31 percent reduction in overall hospital LOS and resulted in $2.3 million in savings for the hospital. When looking at all elements of a multi-faceted ROI analysis, this particular hospital calculated a 9x return on its deployment of tele-ICU services.
More broadly, a typical ICU program will yield material clinical implementation of, and adherence to, best practices and established standards of care. In addition, a well-structured tele-ICU program will also yield significant improvement in the ICU mortality rate and ICU length of stay. ICU CMI and patient volume are often positively impacted. Ventilator days typically drop significantly. A long list of other clinical and financial indicators also typically trend advantageously.
Medical initiatives that are focused only on cost-cutting are typically important, but very challenging. The evidence continues to show that a telemedicine approach to the ICU yields significant improvements in clinical outcomes that are critical to hospital CMOs, in the context of a strong, ROI-driven business use case, benefiting patients, their families, the bedside teams that serve them and the hospitals that form the backbone of our health care delivery system.
About the author: Lou Silverman is the CEO of Advanced ICU Care. He has a 15-year record as a CEO in health care technology and services companies. Silverman also serves on the board of directors for a variety of health care-related companies, both public and private.