Health Care Costs and Financing

Remote intensive care monitoring is cost effective for sickest patients

Treating patients in intensive care units (ICUs) is very expensive, representing nearly a third of all hospital costs in the United States. Such care must be managed by specialty-trained physicians called intensivists, who are in short supply. Telemedicine ICU programs, where patients are monitored by intensivists offsite, are helping to address the shortage of intensivists, but have upfront and operational costs in the millions. A recent study finds that telemedicine ICU programs are cost effective only for the sickest patients.

Researchers compared cost outcomes on 1,913 ICU patients before the tele-ICU was implemented and 2,057 patients cared for under the remote monitoring system. All patients were treated in six ICUs at five hospitals that were part of a large nonprofit healthcare system. Specifically, the researchers analyzed various costs associated with ICU and floor care, as well as the physician and contractor costs associated with the running of the telemedicine ICU.

Hospital daily costs and hospital cost per case increased 24 percent and 43 percent, respectively, after the telemedicine ICU was implemented. The cost per patient also increased 28 percent. The jump in ICU costs accounted for most of these increases. The telemedicine ICU program was not cost effective for the majority of patients but was cost effective for the sickest patients. In the 17 percent of patients who were the sickest, the telemedicine ICU program decreased hospital mortality without a significant boost in costs. It may be more prudent for hospitals to install tele-ICU systems to monitor only the sickest patients rather than putting the program in place for all ICU patients, suggest the authors. Their study was supported in part by the Agency for Healthcare Research and Quality (HS15234).

See "Costs and cost-effectiveness of a telemedicine intensive care unit program in 6 intensive care units in a large health care system," by Luisa Franzini, Ph.D., Kavita R. Sail, Ph.D., Eric J. Thomas, M.D., M.P.H., and Laura Wueste, R.N., M.S.N., in the Journal of Critical Care 26(329), pp. e1-e6, 2011.

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