• Craig M Lilly, Christine Motzkus, Teresa Rincon, Shawn E Cody, Karen Landry, Richard S Irwin, and UMass Memorial Critical Care Operations Group.
• Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology and Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Clinical and Population Health Research Program, UMass Memorial Medical Center, Worcester, MA; Graduate School of Biomedical Sciences, UMass Memorial Medical Center, Worcester, MA. Electronic address: craig.lilly@umassmed.edu.
• Chest. 2017 Feb 1; 151 (2): 286-297.

BackgroundICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge.MethodsPrimary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities.ResultsAnnual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay.ConclusionsThe ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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