We read with interest Dr Hoffman’s comments and appreciate his acknowledgment that there are a number of good reasons to expand ICU telemedicine (tele-ICU) services. We continue to believe that physicians should be reimbursed for tele-ICU services and would like to comment on Dr Hoffman’s four reasons not to do so.
First, Dr Hoffman wrote, “this service is of uncertain benefit, and additional studies to determine the efficacy of tele-ICU monitoring are necessary before a CPT [Current Procedural Terminology]category 1 code should be created.”1 We disagree. To date, there have been 14 studies evaluating tele-ICU clinical outcomes, eight of which have been published in the peer-reviewed literature. We believe that these studies are sufficient to meet the CPT category 1 code requirement that the clinical efficacy of the service/procedure be well established and documented in US peer-reviewed literature. When several of these studies are taken together and evaluated using meta-analysis techniques, a total of 41,374 patient outcomes (15,667 pre-tele-ICU and 25,707 post-tele-ICU) have been reported.2 The largest tele-ICU study to date, as with prior studies, again showed significantly lower mortality and length of stay.3 When all studies are considered together, tele-ICUs clearly show decreased ICU mortality and length of stay.