Tele-ICU may not be cost-efficient at $123K per bed in the first year

The cost of telemedicine intensive care unit (tele-ICU) program implementation is substantial and the impact of these programs on hospital costs or profits is unclear, according to a study in the July issue of the CHEST Journal. Thus, the study authors cautioned administrators to “carefully weigh the clinical and economic aspects of tele-ICU programs when considering investment in this technology.”

Implementation of tele-ICU may improve patient outcomes, but the costs of these programs are unknown. Gaurav Kumar, MD, of the division of pulmonary, critical care, and occupational health at the University of Iowa, Carver College of Medicine in Iowa City, and colleagues performed a systematic literature review to summarize existing data on the costs of tele-ICU, and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals.

To do this, they reviewed studies published between Jan. 1, 1990, and July 1, 2011, reporting costs of tele-ICU programs. This systematic review identified eight studies involving 29 ICUs from 26 hospitals that provided tele-ICU cost data. Then, the researchers obtained the costs of implementing a tele-ICU program in a network of seven VHA hospitals and reported these costs in light of the existing literature.

Technology is “an important component of tele-ICU costs,” the authors commented on the existing IT available within VHA. The VHA already had an advanced EHR; however, this EHR did not have the capabilities of managing continuous critical care data in a clinical information system (CIS). The EHR allowed for documentation and note writing, order entry with decision support, test result data and demographic administrative data.

According to the authors, optimal tele-ICU programs include both an EHR and a real-time critical care CIS. “The VHA tele-ICU implementation did not require purchase of an EHR as the VHA already had an EHR, however the tele-ICU implementation did require purchase of a CIS and these costs are included in our analysis,” they wrote.

These studies suggested combined implementation and first year of operation costs for a tele-ICU program of $50,000 to $100,000 per monitored ICU-bed, according to Kumar et al. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient.

In an analysis of VHA data, the researchers found the total cost for implementation combined with the total first-year tele-ICU operation costs to be $123,000 per ICU bed. When initial investments are depreciated over five years, the combined costs for technology and operation in the first year are estimated at $70,000 to $87,000 per ICU bed.

The authors declared no financial conflicts of interest, but they acknowledged the accounting and financial assistance of the VHA Decision Support System,  Michael Windschitl, RN, MBA, and the Minneapolis VHA Chief Finance Officer LeAnn Stomberg for acquisition of data, analysis of data and critical revision of the manuscript for important intellectual content.