Sunday, August 5, 2012
USA - Unclear if ICU telemedicine can save hospitals money
Remote monitoring of intensive care patients - a strategy to maximize scarce medical expertise - can cost hospitals anywhere from $50,000 to $100,000 per bed in the first year of operation, according to a new study.
Whether this investment pays off in the long run by improving ICU patients' care and saving money, "we don't know," said Dr. Gaurav Kumar, a fellow at the University of Iowa and the lead author of the study published in the journal Chest.
Kumar's review of past research on the costs and benefits of telemedicine in the ICU found a range of estimates of the technology's economic impact - from increasing hospital profits to adding a financial burden.
Some 40 hospitals in the U.S. have implemented so-called Tele-ICUs, according to Kumar, who is also affiliated with the Veterans Administration Medical Center in Iowa City.
Telemedicine in the ICU typically involves transmitting vital signs, test results or images to a central monitoring site, video monitoring of patients, sharing of electronic health records and rapid communication with experts in intensive care.
Because there are not enough of these "intensivists" to staff every ICU in every hospital, the idea is to use communications technologies to let specialists track a larger number of patients across different facilities, such as a network of VA hospitals.
Telemedicine is also appealing to administrators looking to save health care dollars, particularly in expensive areas like intensive care.
"The data is quite clear that early detection and intervention in a patient who (crashes)…makes a big difference in terms of reducing mortality and reducing costs in terms of dollars and human suffering," said Dr. Richard Lofgren, the senior vice president and chief clinical officer of the University HealthSystem Consortium, an association of non-profit hospitals.
Telemedicine allows for more continuous supervision of patients, but Kumar said there have been few studies assessing whether it actually leads to better health outcomes for patients or money saved for insurers or hospitals.
An earlier study found that remotely monitoring ICU patients had little benefit, except to the sickest of patients.
The goal of his study was to first get a benchmark of just how much telemedicine systems cost for a hospital to implement.
Kumar and his colleagues collected previous studies on this topic and found eight reports, covering 29 ICUs and 26 hospitals.
In seven of the studies, hospitals had no intensive care specialists on staff. Four of the studies had authors with ties to Tele-ICU commercial vendors. And only five studies used real-time videoconferencing and 24-hour monitoring.
Based on the eight reports, Kumar's group estimated that it costs $50,000 to $100,000 per bed in the ICU to implement a telemedicine system for a year.
In addition, Kumar and his colleagues looked at the upfront costs of the telemedicine system implemented in their own VA hospital and six others in the same network and found a similar range of $70,000 to $87,000 per ICU bed, per year.
Lofgren said the estimates "seem within the ballpark" of what it costs to implement a telemedicine system.
The studies reported wide differences in how that investment paid off, dollar-wise, however.
Among three studies affiliated with a telemedicine system vendor, remote monitoring increased hospital profits up to $4,000 per patient.
One of the studies, for instance, found that telemedicine systems in ICUs reduced the time patients spent in the ICU by 30 percent, thereby saving the hospitals money on their care.
Two studies that were not sponsored by a vendor company, on the other hand, found either no cost savings or increased expenses.
Kumar said his next study will look at how telemedicine affects patients' health and how well clinicians stick to the "evidence based" practices that are proven to be most effective for patients.
"We don't know," he told Reuters Health, "is Tele-ICU going to be great for those facilities that have no ICU docs, but it really won't add anything for those facilities that already have people on staff?"
Lofgren said he expects that an investment in telemedicine will pay off.
If a hospital spends $70,000 a year on telemedicine, that works out to a little less than $200 per day, per bed, he noted.
"It doesn't take much of a reduction in length of stay...or a reduction in complications, especially in septic patients, to offset $200 (a day) in an environment that is as expensive as an ICU," he said.
Kumar and his colleagues say it is important for hospitals to know the economics of telemedicine and more research is needed.
"For Tele-ICU programs to be sustainable over the long term, hospital administrators will demand rigorous financial analyses of budgetary impact," they wrote. "Long-term viability of Tele-ICU programs will require more detailed data that these programs are cost-effective."