For years the debate as to whether CMS(Medicare) should reimburse physicians for tele-ICU care has been receiving a resounding NO! Their decision is based on their belief that tele-ICU’s cannot be equated with on-site care. While most agree that there is no argument that onsite care is paramount, what is left is whether NO ICU care, especially for hospitals that have no intensivists, is better than Tele-ICU care. Our bias is that tele-ICU care means immediate care for acutely ill patients who without such care have a high risk for death. In addition, tele-ICU care certainly adds that extra expertise to help insure guidelines are followed and up to date evidence-based care is delivered to the 5 bed ICU equal to the care that one gets in the 32 bed ICU located in a large academic or tertiary care hospital.

McCambridge et al in the October issue of Chest believe that based on 13 studies showing  improved patient survival and decreased length of stay for patients receiving tele-ICU should be the basis for providing reimbursement. This means not for just monitoring patients, but actively diagnosing and treating critically ill patients. The long and arduous task to convince those physicians who oppose this is based on finances – sharing that pie that fails to get larger. Realistically, the CMS data accumulated by the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care at eight existing tele-ICU programs revealed critical care charges amounted to 0.04% of the total Medicare charges for all physician services.

The counterpoint by Dr. S. Hoffman from The Ohio State University feels there should not be reimbursement because of uncertain benefit, the hospital is already reimbursing physicians, it serves as a disincentive for onsite care, and it de-values face-to-face care. In response to this is that there are several scientifically based good outcome studies, hospitals could enhance their already narrow financial margins if CMS paid, and the tele-ICU service is an extension which complements an onsite service that is the core value of having an intensivist program. A major barrier such as reimbursement only slows the growth and prevents hospitals that either cannot afford onsite intensivists nor can justify coverage for a few ICU beds. The question we all must weigh is that all patients no matter what their geographic location or financial background should ever be denied access to board certified intensivists? The past thirty years has shown the value of an intensivist team, so why limit our patient’s access to these needed specialists? Science and common sense  we hope will ultimately prevail.