Date post: | 12-Jul-2015 |
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Health & Medicine |
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MEDICAL DEVICES:
THE CHALLENGE FROM
E-ICU
Team DANIN
Marc
Uemura
Mehdi
Sina-Khadiv
Janet
Lim
Ninad M
Deshmukh
Is Something Wrong Here?
The Healthcare Juggernaut
Healthcare Costs in US
$2.4 Trillion
Hospital Care
$720 Billion
ICU Care
$55 Billion
?
What is Wrong with the Current
State of ICU Care?
• Increasing number, activity and costs of ICU patients
• 20% of ICU patients have adverse events
Clinical Challenges
• 54,000 lives could be saved annually with adequate ICU care
• Operations routinely cancelled/ rescheduled due to lack of ICU beds
Lack of Resources
• ICU care comprises 20-34% of total hospital costs
• Only 12% of patients go through ICU
Super High Costs
Who can disrupt the ICU Care
Status Quo?
• Combines high-tech software with Health IT
• Allows Intensivists to care for ICU patients from a remote location
• Possibly reduces costs and improves results
eICU
What can eICUs do?
• Relay vital signs, lab values and other monitored parameters to remote location
• Provide alerts to bring abnormal values to attention
• Provide high resolution monitoring and two-way audio in all patient rooms
• One Intensivist and two critical care nurses can interpret this data and make appropriate clinical decision
• Relay these decisions to on-site clinicians who can carry out these actions
We are The Incumbents
Hospital systems that have not adopted eICU
Academic Medical Institutions
University of California Hospital System
Who are the Insurgents?
Hospital systems that have adopted eICU
Some
Academic
Institutions:
University of Pennsylvania,
University of Mississippi
The US Army:
Tripler Army Hospital in Hawaii to monitor patients
in Guam
Some Private Institutions:
Sentara Healthcare in Virginia,
Advocate Healthcare in Chicago,
Avera Health in South Dakota,
Sutter Health in California,
Geisinger Health System
How Does The ICU Market
Space Look Like?
How Big is Hospital Care?
Total Healthcare Expenditures :
$2.4 Trillion
Hospital Costs:
30% of Total Healthcare Expenditures $720 Billion
4,900 hospitals in US offer in-patient care
36 Million patients treated annually
And how about ICU Care?
12% of hospitalized patients require ICU care
4.2 Million Patients
ICU Patients cost a total of $125-200 billion annually
22-34% of hospital costs
Direct ICU care costs about $35-55 billion annually
20% of total hospital costs ($140 billion)
Do you know?
There are not enough Intensive Care Doctors to take care of everyone
There are only 6,000 Board Certified Intensivists when 24,000 are needed
There are 60,000 adult ICU beds to take care of 4.2 million patients annually
And on top of that…
Adverse Events (E.g. Unexpected Cardiac Arrests):
16.6 per 1000 ICU Patient Days
• Adverse Event: Unintentional injury/complication that resulted in disability/incapacity at the time of ICU discharge, death, or prolonged hospitalization and that was caused by healthcare management rather than the patient’s underlying disease
• 6.1% of deaths were found to be preventable
• 36% of adverse events were preventable
Frequency of Medical errors:
2 errors per patient per day
• Error: Error of Execution/ Error of Planning
The Bottom Line
There exists an untapped market
• Tap it before insurgents capture it
• Address it before an insurgent changes the rules of the game forever
Inefficiencies exist in the ICU ecosystem
• Remove them before they lead you to a slow death
• Address them before insurgents make the system unsustainable
Why Should We The Incumbents
Not Adopt eICU?
Special Patient Base
Academic Institutions get complicated patients with more complex diseases
• Need to be cared for by someone who understands all their medical problems
• With an eICU, the physicians don’t know their patients intimately
Mission & Money
Academic Medical Centers have a mission to teach and do research
• By implementing eICUs, cannot teach residents intimate ICU care
• Importantly, risk losing research funding money linked with direct patient care
And….
• Adverse outcomes from new technology can ruin hospitalsRisk
• Uncertainty in future regulations for eMedicineRegulation
• eICU would not fit into society’s perception of carePerception
• eSecurity: Loopholes may result in compromise with patient dataPrivacy
• Change of status quo can affect team-workChange
Err… what is the strategy?
So What Can Be Done?
The Profit Equation
Revenue Cost Profit
More Patients
Reimbursements
• Private Insurance Companies
• Government: Medicare/ Medicaid
Equipment/ Medications
Staff
• Physicians/ Nurses
Reimbursements are moving towards being dependent on patient outcomes
How Can You Save Costs?
Have A Look At This:
$-
$20,000
$40,000
$60,000
$80,000
ICU Costs: Mechanical Ventilation
Average ICU Cost Per Patient
High - ICU Cost Per Patient
Day 1 Cost
Day 2 Cost
Source: Daily cost of an intensive care unit day: the contribution of mechanical ventilation, Dasta JF, McLaughlin
TP, Mody SH, Piech CT, The Ohio State University, Columbus, OH, USA
0.010.020.030.040.0
Patients Requiring
Mechanical Ventilation
Patients Not Requiring Mechanial Ventilation
D
a
y
s
ICU Stay: Mechanical Ventilation
Average ICU Stay
Upper Limit - ICU Stay
What it means…..
ICU costs are highest on first 2 days and stabilizes after
Mechanical Ventilation is associated with significantly higher costs
Decreasing length of stay or length of mechanical ventilation would decrease costs significantly
Source: Dasta study - “ICU costs”
Finding Efficiencies…
Moving a patient from an ICU to non-ICU hospital bed Cost Savings
• As long as patient’s health outcome is not compromised
• Source: Norris Study – “ICU Costs”
Increase the number of intermediate care beds to transfer patients out of ICU
• If done efficiently, this can increase availability of ICU beds and decrease costs
Finding Efficiencies…
Train Nursing Staff for Sicker Patients
• Patients who are in the ICU can be transferred out more quickly
Make price information available to physicians when they order tests
• Physicians order less tests when they know prices Cost Savings
• Source: Effect of Price information on test ordering in ICU
Changing Mindsets
Create “Closed ICU” Interdisciplinary Team
• Having a Pharmacist in ICU can improve patient outcomes and decrease costs
• Decreased length of stay and mortality
• Lower percentage of re-admission to ICU
• Benefit to Cost ratio of 6:1
Have dedicated “Morbidity and Mortality” Conferences
• Decreases adverse events and costs
• Improves patient outcomes and revenue
Decrease demand for ICU Care
• Laparoscopy instead of Laparatomy
• DaVinci Procedures
Taking Necessary Steps
Improved Profits
More Patients (Revenue) Less Re-admits (Savings)
Improved Care
Less Adverse Events Better reputation
Invest
Intensivists Training Equipment
And Importantly… Focus on Key
Catalysts for Change
• These catalysts will enable providers to get live assistance through internet
• Families can be updated by video conferences/ internet based communication platforms
Web 2.0
• Leverage the cloud to reduce day-to-day operational costs
Cloud
• Faster access for providers anytime, anywhere
• Quick response to patients through alert systems
Smart Phones
Final thoughts
The Big Picture - I
Profits will be driven by improved patient outcomes
• Future of Revenues: Bundled Payments
Efficiencies need to be improved to prevent insurgents from taking over
• We need to cut costs, inefficient archaic methods, all without compromising patient care
The Big Picture - II
We are entering an era of leveraging existing technologies to build new applications
• eICUs have come up at the beginning of this era
Possibly, a much better integrated framework for hospital management in totality might be in the wings
• It might be in our best interest to let the eICU opportunity pass but be ready to adopt the big one coming up
Thank You
Any ?