After 25 years, virtual critical care is getting a closer look.
The time is right for tele-ICU. The need for more intensive-care beds is acute. The cost of caring for critically ill patients has never been higher. Intensivists are in short supply, and only getting scarcer as the population gets older.
That was the case made in a Tuesday afternoon session at the American Telemedicine Association's 18th Annual International Meeting & Trade Show titled "The Tele-ICU: How to Communicate, Compare and Evaluate Models of Care, Technology and Value?"
Herb Rogove, DO, chief executive officer of Ojai, Calif.-based C3O Telemedicine, laid out the numbers: There are 5,800 acute care hospitals in the this country of 312 million people, with some 67,000 ICU beds. More than 55,000 ICU patients are treated each day, he pointed out.
And even though there are more than 40 million people aged 65 and older in this country, there are fewer and fewer physicians who can care for them as they age.
"By the year 2020, we'll be 22 percent shy in number of intensive care physicians needed," said Rogove.
Enter the tele-ICU, a concept that's been around for a quarter-century but has only recently started to get the attention it deserves.
There's more than one way to approach a tele-ICU initiative, said Rogove.
There's the centralized model, in which "you a have a facility – a bunker – in which you have nurses, a doctor and administrative support that goes out to your spoke hospitals and provides that level of care," he said.
Then there's the decentralized approach, which allows physicians to "be anywhere," said Rogove. "Intensivists can be in their office, they can be in their car, they can be at home, using various modes of technology to communicate directly with that hospital."
There are seemingly obvious benefits to implementing one version or the other, he said, such as a reduction in mortality rates and hospital lengths of stay and a positive return on investment. But it's true, too, that there are skeptics who want to see hard evidence. Does mortality really go down? Reduced length of stay? "Prove it."
It's sometimes "difficult to assess financials," he said, and for some facilities the "long-term economic benefit is not clear."
Those barriers so common to other types of telemedicine initiatives can be a huge headache, too, said Rogove. Licensure is "absolutely the most agonizing, ridiculous, costly process you can ever go through," he said. He recalled that one such process took 14 months. Reimbursement is often problematic, of course. And credentialing can be "another costly three-month process."