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."
Reuters
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