| The Leapfrog Group (Leapfrog) and Society of Critical Care Medicine (SCCM) have joined together in calling for the establishment of a national quality standard that would "close" all non-rural hospital Intensive Care Units (ICUs) to patient admissions by physicians who are not Board Certified specialists in Critical Care Medicine---such physician specialists being termed "intensivists." This work speaks to the rationale upon which is based the aforementioned proposed national quality standard, and outlines issues relating to intensivist physician supply that make impossible broad-based compliance with that proposed standard through traditional approaches to medical care delivery. The use of telemedicine technologies to support the provision of certain healthcare services, and the possible feasibility of addressing the proposed intensivist physician standard through the application of telemedicine technologies, are discussed. Tools were developed and are presented for use by managers of community hospitals in assessing whether telemedicine technologies may be a feasible and appropriate means through which to address the proposed ICU intensivist physician staffing standard of Leapfrog and SCCM at their institutions. The tools guide managers in undertaking the structured consideration of institution specific key questions, issues and concerns, as well as in modeling financial and other issues and consequences within the context of institution and circumstance specific planning assumptions. Such issues and consequences may involve, but are not necessarily limited to, issues of physician manpower supply, ICU capacity, electronic medical record and other technology adoption, as well as existing and anticipated Medicare, Medical Assistance and third-party payer reimbursement policies and practices. |
