title: The Business Case for Tele-emergency.
abstract: BACKGROUND
  Tele-emergency is an expanding telehealth service that provides real-time audio/visual consultation delivered by an emergency medicine team to a remote, often rural, emergency department (ED). Financial analyses of tele-emergency in the literature are limited. This article expands the tele-emergency literature to describe the business case for tele-emergency. "Business case" is defined as a reasoned argument, supported by objective data and/or qualitative judgment, to implement or continue a service or product.
  
  
  METHODS
  To evaluate tele-emergency financing from the perspective of a critical access hospital (CAH), 10 financial analysis categories were defined. Telephone interviews, site visits, and financial data from the eEmergency program of Avera Health (Sioux Falls, SD) were used to populate the categories. Avera Health information was augmented with national data where available. Three financial scenarios were then analyzed for CAH profit/loss associated with tele-emergency.
  
  
  RESULTS
  Tele-emergency financial analysis demonstrated an $187,614 profit in a high revenue/low expense scenario, $49,841 profit in a midrange scenario, and $69,588 loss in a low revenue/high expense scenario.
  
  
  CONCLUSIONS
  Tele-emergency may be a profitable rural hospital service line if the participating hospital adjusts ED processes to take advantage of increased revenue/savings opportunities afforded by tele-emergency. Savings due to tele-emergency primarily accrue when physician ED backup and physician ED staffing costs are substituted.
authors.affiliation: 1 Health Management and Policy, University of Iowa , Iowa City, Iowa.
authors.forename: A Clinton
authors.initials: AC
authors.lastname: MacKinney
authors.affiliation: 1 Health Management and Policy, University of Iowa , Iowa City, Iowa.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: 1 Health Management and Policy, University of Iowa , Iowa City, Iowa.
authors.forename: Fred
authors.initials: F
authors.lastname: Ullrich
authors.affiliation: 1 Health Management and Policy, University of Iowa , Iowa City, Iowa.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Ayyagari
authors.affiliation: 2 Avera Health , Sioux Falls, South Dakota.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Bell
authors.affiliation: 1 Health Management and Policy, University of Iowa , Iowa City, Iowa.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Mueller
mesh_terms: D004636:Emergency Service, Hospital / Q000191:economics*; D019538:Health Care Surveys; D007407:Interviews as Topic; D019982:Organizational Case Studies; D013023:South Dakota; D017216:Telemedicine / Q000191:economics*
keywords: business administration/economics; emergency medicine/teletrauma; policy; telehealth