Three days a week, John Bowers pulls the noon-to-7-p.m. shift in an office park eight miles from Sentara Norfolk (Va.) General Hospital, where he is a pulmonary critical-care physician covering the intensive-care units.
Wearing a headset in front of a bank of computer monitors, Bowers communicates with patients and staff in two ICUs with 20 beds between them at 664-bed Norfolk General, analyzes an electronic stream of real-time clinical data and examines each patient through a high-resolution video screen clear enough to note the size of the patient's pupils. He is part of a three-person team that includes a critical-care nurse and an administrative clerk.
This month a 16-bed ICU at 358-bed Sentara Hampton (Va.) General Hospital will be added to the "e-ICU's" caseload.
The telemedicine system is the brainchild of Brian Rosenfeld, M.D., and Michael Breslow, M.D., two former intensive-care specialists--called intensivists--at 840-bed Johns Hopkins Hospital in Baltimore. Also on the faculty at Johns Hopkins Medical School, each doctor had been running ICUs for about 15 years before he gave it up in 1998 to co-found a privately financed Baltimore-based company called IC-USA.
The pair's fortunes will rise or fall on whether the system is one that proves that quality begets big cost savings.
Rosenfeld says selling that concept is the easy part.
"There is no (resistance to) the concept," he says, noting ICUs can represent as much as 25% of a hospital's budget. "Everyone knows the ICU is the last bastion of unmanaged care, and they don't have a clue how to improve it."
Bells and whistles aside, IC-USA simply adds another level of intensive care, making no claims that it will allow hospitals to trim their staffs, Rosenfeld says. Instead, by offering around-the-clock monitoring by board-certified intensivists, the company efficiently manages the expertise of a too-small supply of specialists.
"You go into most ICUs in this country at night, weekends and even sometimes during the day, and you are dependent on the nursing staff to identify problems and alert someone," Rosenfeld says. "That's reactive care, and it leads to complications and costs. Our model has trained people looking at the trends, trying to identify problems before they become problems."
According to Rosenfeld, there are about 5,500 practicing intensivists nationwide. To achieve around-the-clock coverage in all ICUs in this country, 35,000 intensivists would be needed.
That points to only one shortage. ICU nurses, who have supplied "a lot of the glue holding ICUs together," are scarce as well, he says.
With the IC-USA system, the remote team can monitor up to 40 patients at a variety of locations, Rosenfeld says. The lion's share of the cost savings is achieved by reduced lengths of stay because of a lower rate of complications.
Rosenfeld bases his claim on a trial of the system that he and Breslow ran at 655-bed Johns Hopkins Bayview Medical Center, also in Baltimore, involving 650 patients during a four-month period. They reduced mortality rates by 60%, complications by 40% and cost of care by 30%, he says. He claims the system can save $150,000 per ICU bed per year.
Sentara Healthcare, a six-hospital system based in Norfolk, has signed a five-year, multimillion-dollar contract with IC-USA, the company's first contract. Rosenfeld says other contracts are in the offing. Sentara began using the e-ICU earlier this summer.
Rod Hochman, M.D., senior vice president and chief medical officer of Sentara, says the hospital's annual e-ICU costs will be in the $1 million range and projects that the service will yield as much as $2 million in net yearly savings--just by reducing lengths of stay. That figure does not include savings on pharmaceuticals or blood products or the potential reduction in medical errors, Hochman says.
"The beauty is that it represents more caregivers, not less," Hochman says. "This is not a strategy to do with (fewer) nurses."
As the system ramps up, Sentara will hire as many as three more physicians and also plans to make the e-ICU part of the rotation for ICU nurses, "which is a neat way to prevent burnout from being in the trenches of the bedside," Hochman says.
Bowers, who along with Rosenfeld is part of a group of seven intensivists staffing the e-ICU, says there are two virtual shifts: noon to 7 p.m. and 7 p.m. to 7 a.m. Between 7 a.m. and noon, the doctors typically make their in-person rounds.
"I think ultimately what is going to happen is, it will allow us all to work more efficiently," Bowers says.
The IC-USA system still requires approval from the federal Food and Drug Administration for a bedside monitor that is considered a new medical device, although Rosenfeld says he believes the approval is weeks away. IC-USA is in a second round of venture capital financing, this one, for $16 million, led by Pacific Venture Group, Encino, Calif. Cardinal Health Ventures and Abell Foundation kicked in $3.75 million for the initial financing and are back for the second round.
Andrew Pines, a director in the healthcare financing group of investment bankers Salomon Smith Barney, New York, has been advising IC-USA on financing. He believes IC-USA will go public in two to three years or sooner.
"I think physicians can see clearly the value associated with (the IC-USA) program, and once the physicians make it clear that it's not just another big spending, high-tech type of technology, the healthcare executives can see pretty clearly that there will be cost savings associated with it in terms of improved outcomes, shorter lengths of stay and tangible bottom-line benefits," Pines says.