ST. LOUIS, MO — Last month, Mercy unveiled the world’s first Virtual Care Center in the heartland of America. Bishop Edward Rice of the St. Louis Archdiocese officially blessed the nonprofit Catholic health system’s newest facility Oct. 6 in Chesterfield, Mo., a suburb located 15 miles west of St. Louis.

The new $54 million building on a 38-acre campus houses the nation’s largest single-hub electronic intensive care unit (ICU/Mercy SafeWatch), and also provides a center for telemedicine innovation and a testing ground for new healthcare products and services. More than 300 physicians, nurses, specialists, researchers and support staff at the four-story, 125,000-square-foot center are tapping into technology to deliver care to patients around the clock via audio, video and data connections to locations across Mercy and around the country through partnerships with other health care providers and large employers.

“This is a huge and impactful step forward for telehealth and I appreciate that Mercy leadership had the vision and determination to demonstrate to their community and the world how telehealth is one powerful and effective solution to the issue of diminished access to healthcare that many citizens in America and across the globe are experiencing,” said Rena Brewer, CEO of Global Partnership for Telehealth Inc., and director of the Southeastern Telehealth Resource Center.  

Randall Moore, MD, MBA, Mercy Virtual president, spoke with Medical News exclusively about establishing the Virtual Care Center and the positive impact it’s already making on practices, clinics and hospitals across the United States.

How did the idea of Mercy creating a Virtual Care Center originate?

It was an evolutionary process. We launched our first virtual program – Mercy SafeWatch, our electronic ICU– in 2006, and we’ve experienced great success. As the team continued to build programs and saw the importance of virtual care becoming a transformational pathway for our health system, a light bulb went on. It made sense to create a Virtual Care Center that worked like a hospital to bring together teams, resources and infrastructure to care for patients in a much more coordinated manner and to offer a care continuum that extends 24/7/365. We needed a facility for this conduit of care, just as we’d need one for a particular service like cancer care.

How did the concept evolve into the world’s first-of-its-kind telehealth center?

The Virtual Care Center evolves from the culture and charism of Mercy. The Sisters of Mercy who founded our health system were famously known as ‘the walking sisters.’ That goes back 187 years, when nuns were mostly cloistered and did good deeds from their convent for people in need. The walking sisters, who were quite independent, didn’t want to wait for people to find them. Instead, they searched for people in need and addressed those needs on the spot. They were an anomaly for their time.

When you think about hospitals in general, we wait for people to come to us, and we give them exceptional care. The idea permeating our culture was to seek those needing medical care by taking virtual care teams from our clinics and hospitals and proactively identifying their healthcare needs, intervening with them earlier and more completely. It translates to a lower cost, high impact option to keep a person from deteriorating.

At the board level and leadership level, (Mercy president and CEO) Lynn Britton and (Mercy CFO) Shannon Sock were the primary drivers of this project, understanding the Virtual Care Center is 100 percent consistent with our organizational mission – and also a model for us to progressively replace our hospital-based care with care when and where people need it. If we do this well, we’ll be able to realign our contracts to be rewarded for keeping people well.

How have you made the Virtual Care Center a sustainable business model while also dealing with the complexities of regulations, interstate commerce, and the like?

First, it’s important to know we didn’t go into the Virtual Care Center thinking that a fee-for-service equivalent would make it a sustainable business model. We weren’t expecting, though we’d have welcomed it, very much direct reimbursement as has panned out. In Missouri, our parity laws have helped.

We’re broadening it to enable us to move our teams and our patient centricity from our facilities, which are somewhat limiting, to virtual care anytime, anywhere. If we did that with something like performance-based, population health contracts, we could intervene earlier and more effectively, and then it would pay for itself.

For example, here’s how it works in today’s environment in the hospital ICU vs. the floor. In the hospital ICU, the hospital is paid a lump sum for a patient with a given condition and it’s a fixed amount of money. The ICU is more expensive, and the patient usually doesn’t have as good an outcome. One result of our Mercy SafeWatch program shows the actual v. predicted mortality for the last few quarters in our Joplin (Mo.) hospital has been running around 50 to 55 percent. In other words, 45 to 50 percent of the patients who ‘should’ve’ died didn’t. That statistic doesn’t help much with finances, right? It should help us with market differentiation; by having Mercy SafeWatch in place, we can do a better job taking care of people. But here’s another example: Looking at the risk-predicted length of stay, both in the hospital and the ICU, our length of stay is running 20 to 30 percent less than predicted in the ICU, and 30 to 35 percent less than predicted on the whole hospitalization. If we can get a sick person well faster, that’s less time for the patient in the ICU. Looking at it financially, the direct variable ICU costs us about of $900 a day. If it costs us $650 a day to use Mercy SafeWatch, then we’re getting 100 percent return on our investment of virtual care without being paid directly for it.

But the most important aspect is that a third of the ICU patients predicted to die aren’t dying. That’s just the tip of the iceberg, and it implies that patients accessing the Virtual Care Center are doing better. We expect to deliver more efficient, effective, and higher impact care as we integrate virtual into bedside and clinic care.

What’s Mercy’s longer-term goal for the Virtual Care Center?

One of our key growth areas for our mission is to create the Virtual Care Center as a conduit of care anyone, anywhere can access. We’ve been on a 10-year, several hundred million dollar journey to get where we are. We’ve learned many positive things, and we continue to learn from missteps.

We’re proposing that instead of selling our services, or having an entity trying to replicate the same services without us being able to provide much support, we’d like to build a national consortium of interdependent partners. We’d continue packaging our offerings and building our infrastructure with our partners’ support. They could buy into our entity, we could capitalize it together and replicate what we’ve learned with a fraction of time and money, and also do it in an interdependent way so we could then go to GM, Boeing, CMS, United Healthcare to offer it to people they’re covering throughout the 50 states.

.

LINKS:

Time-lapse construction video: http://bit.ly/VCCvideo