Maine hospitals disband remote ICU program, citing costs

By Jackie Farwell, BDN Staff
Posted Aug. 02, 2013, at 4:31 p.m.

PORTLAND, Maine — MaineHealth will discontinue a program launched eight years ago to improve treatment of critically ill patients by remotely linking hospital intensive care units to off-site medical specialists, the health system announced Friday.

Budget constraints led the Portland health system and nine participating hospitals to discontinue the program, called VitalNetwork, effective Oct. 1, according to Mark Harris, MaineHealth’s senior vice president of planning and marketing.

“We would be running a deficit of more than half a million dollars [a year] to run it,” he said.

The hospitals, including four outside the MaineHealth system, pay fees to participate.

The computerized system tracks the vital signs and other medical information of patients in intensive and critical care units, then beams it to a Portland command center staffed 24 hours a day by specially trained doctors and nurses. The command center’s staff communicate with medical personnel at the hospitals through a video connection at patients’ bedsides.

Rather than replace local medical personnel, “eICUs” or “teleICUs” are designed to give hospital staff, particularly in rural areas, access to doctors and nurses trained in critical care who can monitor patients for signs of trouble and step in remotely before complications become life-threatening.

Many hospitals don’t have ICU specialists working at night or on weekends.

“It’s kind of like a second set of eyes,” Harris said.

TeleICUs first caught on in the U.S. in the early 2000s, as hospitals struggled to address the converging trends of an aging population, leading to more and sicker critical care patients, and a dwindling supply of intensive care specialists available to treat them.

In Maine, some hospitals could no longer afford to participate because insurers don’t reimburse them for the costs of providing the VitalNetwork service, according to MaineHealth. With fewer hospitals supporting the program, the fixed costs made it “impossible to run the program in a cost-effective way for the remaining organizations,” Dr. Vance Brown, MaineHealth’s chief medical officer, said in a Friday press release.

Franklin Memorial Hospital in Farmington, which joined VitalNetwork more than four years ago, will save roughly $100,000 to $150,000 a year in fees it paid to participate, according to Chief Information Officer Ralph Johnson.

“While the service is fantastic for our patients, it’s not reimbursable,” he said. “As with most of the hospitals around the state … we had to trim a number of expenses, and I’m sure MaineHealth faced the same thing.”

Franklin, which has four ICU beds, understood the reasons for disbanding VitalNetwork but is disappointed to see the program end, he said.

“The consequence of this will be that some patients that may have stayed in the local community may have to travel further for care that we won’t be able to offer,” he said.

Other hospitals, however, have managed to save money while improving care using teleICU programs, according to Wendy Everett, president of the Massachusetts-based New England Healthcare Institute, a nonprofit health policy organization.

Many health systems have found teleICU systems lead to fewer deaths and much earlier medical interventions when problems crop up, she said. Because patients are so closely monitored, they often avoid complications such as pneumonia and get better more quickly, leading to shorter ICU stays that save hospitals money, she said.

TeleICU programs also allow community hospitals in rural areas to keep patients who would otherwise need to travel to bigger hospitals for treatment, Everett said.

“That’s better for the families who don’t have to drive three hours to see their mom or their kid, and you, as the community hospital, are able to keep the revenue for taking care of that patient,” she said. “Hospitals who have done it, by and large, and who have implemented it appropriately, have also been able to save money.”

MaineHealth touted VitalNetwork’s potential to save lives and dollars upon announcing its deal with VISICU, a Maryland teleICU provider and health technology company, in 2005.

While some hospitals participating in VitalNetwork saw shorter ICU stays among patients, MaineHealth ultimately couldn’t distinguish whether VitalNetwork or better local care was responsible, making it difficult to justify the program’s expense, Harris said.

TeleICUs are expensive to set up, anywhere from $6 million to $8 million to establish a command center, acquire and install the technology, and pay the staff’s initial salaries, according to a 2010 study by the New England Healthcare Institute. Upfront costs for satellite hospitals ranged from $300,000 to $500,000.

Hospitals recovered those costs in less than a year.

Harris said he was unable to provide startup costs for VitalNetwork, and pointed to the program’s continuing operating costs, primarily staff. MaineHealth and the other VitalNetwork hospitals considered spreading the costs among the remaining organizations, enlisting new hospitals, limiting hours of operation and reducing staff, but none of those options would have enabled the program to continue, according to the health system.

Still, the years of collaboration among doctors and nurses has led to better ICU care for Maine patients, Harris said.

“The regional network of ICU professionals that came about as a result of VitalNetwork will continue to benefit patients as the group will keep on providing team-based care and sharing innovations in care,” the release stated.

MaineHealth said it has found other positions within the system for the 15 VitalNetwork employees whose jobs are being eliminated. The system also is investigating other options for hospitals that want to continue providing a critical care monitoring system, which will likely involve connecting them to another organization.

The nine VitalNetwork hospitals are MaineHealth members Maine Medical Center in Portland, Miles Memorial Hospital in Damariscotta, Pen Bay Medical Center in Rockport, Southern Maine Medical Center in Biddeford and Waldo County General Hospital in Belfast, along with

Farmington’s Franklin Memorial Hospital, MaineGeneral Medical Center in Augusta and Waterville, Mercy Hospital in Portland and St. Mary’s Regional Medical Center in Lewiston.

 

http://bangordailynews.com/2013/08/02/health/maine-hospitals-disband-remote-icu-program-citing-costs/ printed on October 31, 2014