Tele-ICUs put rural Georgia on the map

By Erin McCann
09:21 AM

Project sees big winnings, bigger savings for Medicare patients

ATLANTA – With the highest mortality rate in healthcare and costing hospitals an estimated $180 billion each year, intensive care units (ICUs) are established regulars in the health IT reform spotlight.

Emory University, in collaboration with several medical centers throughout Georgia, seeks to improve the denigrated face of ICUs. Utilizing Philips eICU technology, the project will provide telehealth intensive critical care to underserved, rural hospitals in Northern Georgia, reaching more than 10,000 Medicare and Medicaid beneficiaries.

The Emory collaboration, a partnership of colleagues at St. Joseph’s Hospital, Northeast Georgia Hospital and Southern Regional Medical Center, earned a $10.7 million Health Care Innovation award from the Center for Medicare and Medicaid (CMS) for the project’s mission to improve the quality of patient critical care while also reducing cost inefficiencies.

Projected to save an estimated $18.4 million over the course of three years, the award will be used to employ more than 40 critical care providers while also providing training and support for 400 critical care and administrative professionals.

Timothy Buchman, MD, director of the Emory Center for Critical Care said one driving force behind the project was the need to address several serious problems ICUs are faced with today.

First, as Buchman explained, “there aren’t enough intensive care doctors being produced to meet the need.” As a consequence, underserved and rural hospitals, in particular, are not receiving the same quality of patient critical care and are in serious shortage of critical care physicians.

A second problem, Buchman continued, is that staffing a rural ICU with enough intensive care physicians becomes “prohibitively expensive,” as intensive care doctors cost a pretty penny.
The shortage and cost of critical care providers also collide with another issue: the nation’s rapidly increasing aging population.

Aside from pediatrics, ICUs predominantly consist of Medicare beneficiaries. In 2000, there were more than 39 million Medicare beneficiaries; in 2011, that number increased to nearly 48 million. That’s a massive increase in the number of patients who are likely to need critical care services.

Moreover, looking at the combined expenses, bringing an ICU bed online for a single patient costs between $2 and $2.5 million. That’s a number guaranteed to give hospital CFOs the jitters.

These combined complications facing the critical care system prompted the Emory collaborative to implement a non-physician providers training program, where community nurse practitioners and physician assistants go to Emory for six months of advanced intensivist training, then return to their communities with the skills needed to provide quality eICU care.

Thorough training is the key to successful telehealth outcomes said Craig Lilly, MD, lead author of a 2011 JAMA study that found tele-ICU technology decreased mortality rates and patient stay times. Lilly pointed out, “Having machines doesn’t guarantee they’ll be used effectively.” So, ultimately, he said, “Your clinicians need to be trained to use the tools of technology effectively.”

Upon training completion, these non-physician providers would be stationed in one of the eICU centers, a station James Bailey, MD, co-director of Northeast Georgia Critical Care Collaborative, CMIO of Northeast Georgia Health System, described as a center with a “primary data feed that would include all the vital sign data, all the laboratory data, the ability to access radiology images and the ability to access the EMR in whatever hospital the patient’s in.” He adds that another significant component of the command center is the direct line for the nurse to call in and “actually turn on the HD camera so that the eICU team can look at the patient and observe the patient from the command center.”

The advantages of this technology are not in short supply, as Allana Cummings, CIO Northeast Georgia Health System, pointed out. The eICU technology allows the “patients to be able to stay closer to home,” a very significant component, Cummings added, as constant traveling by a critically ill patient to faraway medical centers can really be a hardship for the families, “especially considering the support system families and friends offer to patients who live in some of the more rural communities.”

Altogether, Cummings said, this technology is a win-win for Northern Georgia: “We think the outcomes for patient care and the cost-saving opportunities for healthcare overall really present a strong support for this type of care model.”

But will these eICUs compromise quality of care? Bailey responded, “An affiliate provider, when they’re tapped with more focused work, can provide just outstanding care,” and “once you’ve worked with an experienced critical care provider, I think that pretty much makes you a believer.”

So, whether or not you proclaim yourself as the next telehealth disciple, the benefits – proponents declare – are glaring.

Buchman concluded, “If we’re going to be effective in caring for these complex biological systems that we call patients, we have to gain insight into their present state and how that state is evolving much quicker and much more reliably, and with modern healthcare IT, we can accomplish that.”