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

Tele-ICU adoption has expanded, yet no validated claims-based method exists to identify tele-ICU capability or utilization. Reliance on self-reported survey data limits national assessment of delivery models and outcomes.

To develop a Medicare claims-based approach to identify tele-ICU capability and utilization, evaluate concordance with the American Hospital Association Annual Survey Database (AHAASD), and describe hospital and patient characteristics.

Retrospective cross-sectional study using 2021 Medicare 5% Limited Data Set Part A and B claims and the 2021 AHAASD. Tele-ICU-capable hospitals were identified using tele-ICU claims among Medicare beneficiaries during inpatient hospitalizations and emergency department visits and defined as hospitals with ≥1 claim. We compared these hospitals with hospitals reporting tele-ICU capability in the AHAASD.

We identified 1193 tele-ICU claims from 344 hospitals. Among 3932 AHA respondents, 947 reported tele-ICU capability; 110 hospitals were identified by both methods. Relative to AHAASD, claims exhibited 11.6% sensitivity, 95.0% specificity, and 42.6% positive predictive value. Most hospitals submitted 1-2 claims, while a minority generated most claims. Compared with tele-ICU hospitals identified by AHAASD, hospitals identified only by claims were more likely to be rural, for-profit, noncritical access, and had more ICU beds and ventilators but fewer intensivists. Among 1,008,106 ICU patients, 680 (0.1%) had tele-ICU claims and demonstrated higher acuity.

Tele-ICU claims identify a small, specific subset of hospitals actively billing for tele-ICU care and capture clinically meaningful encounters. Combining claims with survey data may improve national measurement of tele-ICU adoption and inform operational and policy assessments.