The Impact of Enhanced Critical Care Training and 24/7 (Tele-ICU) Support on Medicare Spending and Postdischarge Utilization Patterns

ObjectiveTo estimate the effect of implementing a tele-ICU and a critical care residency training program for advanced practice providers on service utilization and total Medicare episode spending. Data Sources/Study SettingsMedicare claims data for fee-for-service beneficiaries at 12 large, inpatient hospitals in the Atlanta Hospital Referral Region. Study DesignDifference-in-differences design where changes in spending and utilization for Medicare beneficiaries eligible for treatment in participating ICUs was compared to changes in a comparison group of clinically similar beneficiaries treated at similar hospitals' ICUs in the same hospital referral region. Extraction MethodsUsing Medicare claims data from January 2010 through June 2015, we defined measures of Medicare episode spending during the ICU stay and subsequent 60days after discharge, and utilization measures within 30 and 60days after discharge. Principal FindingsImplementation of the advanced practice provider residencyprogram and tele-ICU was associated with a significant reduction in average Medicare spending per episode, primarily driven by reduced readmissions within 60days and substitution of home health care for institutional postacute care. ConclusionsInnovations in workforce training and technology specific to the ICU may be useful in addressing the shortage of intensivist physicians, yielding benefits to patients and payers.