title: ICU Telemedicine Program Financial Outcomes.
abstract: ICU 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.
  
  
  
  Primary 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.
  
  
  
  Annual 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.
  
  
  
  The 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.
authors.affiliation: 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.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
authors.affiliation: Clinical and Population Health Research Program, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Christine
authors.initials: C
authors.lastname: Motzkus
authors.affiliation: Department of Nursing, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rincon
authors.affiliation: UMass Memorial Health Care, UMass Memorial Medical Center, Worcester, MA; Department of Nursing, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Shawn E
authors.initials: SE
authors.lastname: Cody
authors.affiliation: UMass Memorial Health Care, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Karen
authors.initials: K
authors.lastname: Landry
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Graduate School of Nursing Sciences, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers; D000368:Aged; D003422:Critical Care / Q000191:economics*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D017216:Telemedicine / Q000191:economics*
keywords: case volume; costs; direct contribution margin; processes of care; revenue