While the high startup costs associated with telemedicine programs have presented a barrier to many rural hospitals, data suggests they contribute to lower costs and lower mortality rates.
“However keep in mind this discussion centers around only the eICU solution which is not the only technology to provide ICU care” according to Dr. Herb Rogove, DO, FCCM of C3O Telemedicine. ICU beds account for about 7% of total acute care hospital beds in the United States but generate 13.4% of total spending, with the cost of an inpatient stay ranging from $2,500 to $4,000 per day, according to the Society of Critical Care Medicine.
The New England Healthcare Institute (NEHI) issued a report in 2012, that there were 54 civilian and government tele-ICU monitoring centers in the U.S. “The NEHI report states “most indicators suggest that use of tele-ICUs is on the threshold of major change” and increased competition among providers is likely to “push tele-ICU care toward a more scalable and potentially more widely available technology,” the report says.
Tele-ICUs are also being promoted as a way to expand the ICU capacity of hospitals to accommodate an aging U.S. population and shortage of intensivists. “It could go a long way to addressing a major problem in that there are not enough intensivists in the health system to care for an aging population of baby boomers,” says NEHI’s Nick King, one of the authors of the report. The NEHI report estimates that per-hospital startup costs range from $100,000 to $200,000, with added expenses for equipment such as mobile carts.”The upfront costs can be an issue, but we’ve demonstrated that health systems can see a return on investment from tele-ICU programs in as little as nine months,” says NEHI president Wendy Everett.The University of  Massachusetts was able to reduce its ICU patient mortality rates by 30% during the first year of its program; it also reported a reduction in hospital-acquired infections and other complications that often result in longer hospital stays.John Muir Health  in northern California, launched its tele-ICU program in 2007 and after 18 months, reported a 45% reduction in ICU mortality rates and a 54% reduction in the average length of stay (LOS) for ICU patient

Rural adoption
Of the 54 tele-ICU monitoring centers in the United States, only 21 involve rural or critical access hospitals. The NEHI report noted that the key impediments to tele-ICU coverage of rural and critical access hospitals have been the costs of extending and maintaining coverage to a limited number of ICU beds and a lack of bedside clinicians in these hospitals to implement care directed from the tele-ICU.

The NEHI report notes a change in that Missouri-based Mercy Health System, which currently has one of the largest tele-ICU programs in the U.S. covering 480 beds, recently received a federal grant to extend coverage to 24 rural hospital beds. Mercy’s program, launched in 2007, has produced a 30% reduction in ICU mortality rates and a 20% drop in patient LOS that saves an estimated $25 million per year.

Options for Rural Success
Though rural tele-ICU networks are rare, there have been several successful networks that could provide a template for success. In Maine, Maine Health had eight rural hospitals coordinating ICU care through a program established in 2005 (though it was successful, the program was shut down in October 2013 when it ran out of funding).

Avera Health in Washington also sponsors a rural tele-ICU program as well as other telehealth programs.

According to Everett, extending ICU programs to rural hospitals has benefits beyond cost savings and avoidance of a patient’s family and friends  traveling several hours to visit them because the local hospital doesn’t have the resources to care for them.

Other Options

C3O Telemedicine is currently providing assistance to Dignity Health in initiating and implementing tele-ICU programs at rural facilities. At the end of 2013, Dignity began a program at Mark Twain Medical Center in San Andreas, California. The concept of Round and Respond will be monitored for the same quality outcomes of the eICU technology reported by NEHI. Dignity has selected the InTouch Robot as it’s technology along with enhanced ICU staff training.

(Annotated from Health Leaders Media, 2014)