A Novel Medicare Claims-Based Approach to Identifying Tele-ICU Capability and Utilization Across US Hospitals

Area of Science:

• Health Services Research
• Health Informatics
• Critical Care Medicine

Background:

• Tele-ICU (remote critical care) adoption is growing, but a validated claims-based method for assessing its capability or utilization is lacking.
• Current reliance on self-reported survey data hinders national evaluation of tele-ICU delivery models and outcomes.

Purpose of the Study:

• To develop a Medicare claims-based approach for identifying tele-ICU capability and utilization.
• To evaluate the concordance of this claims-based method with the American Hospital Association Annual Survey Database (AHAASD).
• To describe the characteristics of hospitals and patients associated with tele-ICU claims.

Main Methods:

• A retrospective cross-sectional study using 2021 Medicare claims (5% Limited Data Set) and the 2021 AHAASD.
• Tele-ICU capability was identified using tele-ICU claims among Medicare beneficiaries during inpatient and emergency department visits.
• Claims-identified hospitals were compared with those reporting tele-ICU capability in the AHAASD.

Main Results:

• 1193 tele-ICU claims from 344 hospitals were identified. Claims data showed 11.6% sensitivity and 95.0% specificity compared to AHAASD.
• Hospitals identified solely by claims were more likely to be rural, for-profit, and have more ICU beds and ventilators.
• Among over 1 million ICU patients, only 0.1% had tele-ICU claims, indicating higher patient acuity.

Conclusions:

• Medicare claims identify a specific subset of hospitals actively billing for tele-ICU care and capture clinically meaningful encounters.
• The claims-based method has limitations in sensitivity but high specificity for identifying tele-ICU capability.
• Integrating claims data with survey data could enhance national measurement of tele-ICU adoption and inform policy.