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Quantifiable benefits of efficiency  
PROFITING FROM TELE-PRESENCE
OF INTENSIVISTS
Annualized results from two intensive-care units at Sentara Norfolk (Va.) General Hospital
  Clinical, operational impact (% change)  
    General ICU Vascular ICU  
  Length of stay while in intensive care -16% -17%  
  Length of stay when transferred to floor -9 -24  
  ICU patient volume +19 +21  
  Change in death rates -28 -21  
   
  Financial Impact  
  Per-case net savings from length of stay reduction $750 $1,900  
  Per-case net savings from cost reduction 1,030 650  
  Total per-case savings 1,780 2,550  
   
  Source: Cap Gemini Ernst & Young MH/John Hall  

Although some experts for years have insisted that improved quality would reduce costs, did anyone truly believe that saving lives with cutting-edge technology could really save money?

Long before the Institute of Medicine’s 1999 damning report on hospital errors and even longer before the powerful Leapfrog Group set three gold standards for patient safety, Bernd says he proselytized that "the best potential for prosperity and improvement in healthcare was through clinical intervention."

But even Bernd was somewhat disbelieving at the start of the eICU® project, promising Hochman that he would put him on a pedestal if it didn’t cost anything, Hochman says.

The eICU®’s operation met that mark and more, delivering a 150% return on the system’s annual investment of $2 million, Hochman says.

The $3 million net savings is the result of a 26% reduction in hospital costs for ICU patients. A shorter length of stay; a lower use of supplies, laboratory tests, therapies and medications; and a 4% decrease in nursing hours worked per patient day helped to reduce costs, according to the Cap Gemini Ernst & Young analysis. The savings worked out to $2,150 for each patient.

The additional ICU cases that came in as a result of reducing the length of stay brought in an extra $460,000 monthly in gross revenue, and a $274,000 bonus contribution to the bottom line after subtracting costs.

The $3 million in savings accounts for about 7% of Sentara’s $40 million profit margin on $1.3 billion in revenue, Bernd notes.

Sentara is practically giddy over the results.

"For our organization, this is our biggest home run – almost ever," Hochman says.

"Everybody assumes you pay for quality when it comes to healthcare, but it turns out to be less expensive," says Brian Rosenfeld, M.D., VISICU’s chief medical officer, executive vice president and co-founder. "I don’t think people in Washington appreciate that. That to me is the 12-second sound bite for this whole analysis."

As the alpha site testing the VISICU system, Sentara is nearly two years into a five-year contract. The hospital system won’t disclose details of the agreement, but it’s more of a partnership than a relationship between vendor and customer, Hochman says.

Rosenfeld says depending on volume discounts, the system can cost anywhere from $30,000 to $50,000 per bed. The company is aiming to go public in 2003, he says.

Spreading intensivists around
Bernd says it was the problem posed by cash-burning ICU operations in general, not any particular problem at Sentara, that brought Sentara and VISIC together. He says he was acutely aware that ICU days represent a small amount of a hospital’s admissions but an alarming majority of a hospital’s operating costs.

"I intuitively figured there was great potential to improve clinical outcomes through improving ICU care," Bernd says.

So Bernd was game when a retired colleague called to tell him about VISICU’s fledgling inroads into managing ICU care. This was some time before the Leapfrog Group identified the ICU as one of three hospital venues for patient-safety standards that could offer the basis for provider performance comparisons.

According to the daunting standard, based on research showing a direct correlation between the level of training of the ICU personnel and the quality of patient care, board-certified critical-care physicians should work exclusively in a hospital ICU a minimum of eight hours per day.

At other times, a critical-care specialist, known also as an intensivist, should be available to return more than 95% of ICU pages within five minutes of being called.

As additional backup, intensivists also should be able to rely on a hospital-based doctor who can reach 95% of the ICU cases within five minutes, according to the standard.

Critics charge the Leapfrog criteria would require more intensivists nationwide than there are to go around. Gene Burke, M.D., Sentara’s eICU® medical director, says a nationwide supply of 30,000 intensivists would be needed – five times the 6,000 intensivists.

Despite the shortage, VISICU’s aim never has been to reduce ICU staffing but to supply an extra level of care, Rosenfeld says. It is simply the difference between reactive and proactive care.

"This is supplemental care, but right now most hospitals don’t have intensivists on site 24 hours a day, seven days a week. Even those that do are covering multiple ICUs, so they are running from one to the next putting out fires or trying to sleep, whereas the eICU® is totally designed like air traffic control," Rosenfeld says. "With one click (an intensivist) can go from hospital to hospital." That leverages the scarce physician commodity throughout multiple ICUs, he says.

Sentara’s ICU operating costs in 2001 totaled $28.5 million. Its six hospitals operate 13 ICUs with about 150 beds. The exact staffing needs and accompanying costs are difficult to pin down because the ICUs are open to almost any community physician with hospital privileges who would like to treat patients there, Burke says.

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