“I don’t understand who can afford this? I mean who really can afford this?” he says.  “I can pay it, but I can’t afford it.”

The premium for his family of five came to more than $40,000 a year. That’s for a bare bones plan with a $10,000 deductible that he buys through the marketplace set up by the Affordable Care Act.

But Alaska is a special case.  It has the highest premiums in the country, and it has seen some of the highest percentage increases over the past two years. That makes paying for insurance especially difficult for families like the Ebbessons.

Ebbesson doesn’t qualify for a subsidy to help pay for insurance because his family income is more than $142,000 a year. But, he says, his insurance costs more than his mortgage.

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“I’m not able to put money in retirement, savings for my kid for college, my ten year old. Believe me I could find lots of stuff to do for my future with $40,000,”  he says.

Ebbesson supports the Affordable Care Act. He calls the Alaska rates a wrinkle in the law that needs to be fixed.

The for a 40-year-old in Anchorage is $719 a month – more than double the national average, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Most Alaskans, and , qualify for a subsidy that rises with premium increases – insulating consumers from big jumps. But about 5,000 Alaskans pay full sticker price.

“We want people to have access to affordable coverage and that’s not happening right now in the marketplace in Alaska,” says Eric Earling, a spokesman with insurer Premera Alaska.

Premera is one of only two companies selling on Alaska’s exchange. Earling says even with the high prices, the company is losing millions of dollars on Alaska’s tiny individual market.  In the first six months of this year, 37 Premera customers filed over $11 million in claims, Earling says.

“The important thing is they deserve access to coverage, and we’re glad they have it,” he says. “The trick is creating a sustainable environment where those costs can be absorbed in a way that doesn’t adversely impact all consumers.”

Premera is backing legislation to use Alaska’s high risk pool, which will allow the biggest claims to be paid by a special fund.

The state’s Division of Insurance hasn’t taken a position on the idea.

Victoria Cronquist is a dental hygienist in Anchorage. She doesn’t care what the solution is, as long as it helps her find more affordable insurance.

“It’s just getting too expensive,” she says. “I’m up against the wall. I can’t do it all.”

This year, she pays $1,600 a month for herself, her husband and two kids, ages 16 and 20. She gets a stipend from her work to help pay that premium, but her rate is going up to $2,600 a month next year. And her stipend isn’t going up. Cronquist says she may cancel her insurance.

“To be quite frank, to have a $2,600 monthly premium payment and all this is stressful to me. Extremely. And that increases my odds of getting ill! That’s the other way I look at it,” she says.

Cronquist doesn’t take the decision lightly. Her family has dropped health coverage in the past. And they paid the price when her daughter ended up in the ICU a few months later.

Ebbesson also has a difficult decision ahead.  He’s thinking about dropping his policy and saving money instead. Ebbesson says his family could fly to Thailand for any big medical procedures that were necessary. If something catastrophic happened though, it would put his family in a tough position.

“It’s a scary proposition. There’s always bankruptcy but, my goodness, why should I be having to even think about things like that related to my health insurance?” he says.

The high rates will push more Alaskans into a category that allows them to avoid paying the penalty for going uninsured. The law includes an “unaffordability” exemption if the lowest cost insurance amounts to more than eight percent of income.

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But for Walker, it’s a no-brainer. Around 40,000 low-income Alaskans — mostly childless adults — would receive health benefits under Medicaid expansion. The federal government would pay 100 percent of the costs until the end of 2016. After that, the state’s share would slowly increase to 10 percent by 2020. Plus, he says, Alaskans already pay taxes that fund the expansion.

“I always will default back to what is best for Alaskans, and it’s best for Alaskans to have the health care coverage we’ve already paid for,” says Walker, who took office Dec. 1.

The Alaska Chamber of Commerce, the Alaska State Hospital and Nursing Home Association and the Alaska Native Tribal Health Consortium all support expansion. So far  have expanded Medicaid, and Laura Snyder with the Kaiser Family Foundation says most of those governors have had legislative support. (KHN is an editorially independent program of the foundation.)

“There have been a few states where the governor has acted on his own through executive authority,” she says, “but most states have generally incorporated it into state budgets which usually require legislative sign off.”

“It will be a lively debate, but I look forward to work with him to the best of my abilities within the financial constraints that this state is currently facing,” she says.

To help his case, Walker has appointed  as health commissioner. She’s been a leader in the Alaska Native health care system and a determined advocate for expansion since the health law passed. She says she’ll rely on a cooperative work ethic as she negotiates with lawmakers over expansion. Davidson is confident Alaska can get it done.

“It may not be something everyone’s 100 percent happy with, but we may be able to find middle ground that we can all live with,” she says. “I think that’s what makes Alaska so great. We don’t back down just because things get difficult. If it’s 40 below we go about our day and get things done. That’s just what we do. And we do that with policy issues as well.”

Beyond the legislature, Alaska faces big technical hurdles before Medicaid expansion can work. The state’s payment and enrollment systems  right now and Davidson wants to address those issues before any expansion.

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“The only one that possibly applied to me was disaster,” Korshin says. “So I picked disaster and I described my disaster as old age and I submitted as my supporting document a copy of my passport.”

Korshin knew that argument probably wouldn’t work, but he still won’t make the switch. Starting next year, the federal government will penalize him – withholding 1 percent of his Medicare payments.

EHR,  ICD-10 and PQRS may sound like alphabet soup. But most doctors around the country know exactly what those acronyms stand for. They are programs championed by the federal government to improve quality and bring medicine into the electronic age. But in Alaska, where small medical practices and an aging physician workforce are common, the new requirements can be a heavy burden.

Korshin practices three days a week in the same small office in east Anchorage he’s had for three decades. Many of his patients have aged into their Medicare years right along with him.

Korshin has just one employee, a part-time nurse. And his lease runs out in four years, when he will be 75 and expects to retire.  He says for his tiny practice, an electronic medical records system would cost too much to set up and to maintain.

“No possible business model would endorse that kind of implementation in a practice situated like mine, it’s crazy,” he says.

Korshin will lose another 1.5 percent of his Medicare payments next year for failing to enroll in PQRS, a federal program that requires doctors to report quality data.  And then there is ICD-10, a new coding system for medical bills — also set to take effect in the fall of 2015.

“This flurry of things one has to comply with,” Korshin says, “means that unless you work for a large organization like a hospital that can devote staff and time to dealing with these issues, there’s no economy of scale, I can’t share these expenses with anybody.”

Alaska State Medical Association Executive Director Mike Haugen says half of the doctors in Alaska are over the age of 50 and very few are employed by large organizations.

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Providence estimates it will lose more than $500,000 in federal payments starting in October. Fairbanks Memorial Hospital calculates its lost payments could be as much as $400,000. Both Alaska Regional and Alaska Native Medical Center estimate their penalties will cost them around $200,000. That is 1 percent of their Medicare payments.

Central line infections are one of three measures that Medicare tracked to decide which hospitals will be penalized. Central lines are IV’s inserted in veins that lead right to a patient’s heart, and infections there are serious. In 2012, Providence Alaska Medical Center in Anchorage had 17 of them in their intensive care units.

“There was no one single thing, there’s no smoking gun, ‘we were not doing x,’” said Dr. Dick Mandsager, Providence’s hospital administrator. He says the hospital had already begun to address the infections with emphasis on safety for patients with central lines. In 2013, Providence had six central line infections instead of 17.

“It’s making sure that the whole bundle of care is done every single time, all the time, regardless of how pressured you are, regardless of how many things you’ve got on your mind,” Mandsager said.

The spike in central line infections in 2012 helped push Providence into the lowest quarter of hospitals nationally for safety measures Medicare is tracking. The analysis is preliminary, but the fines are unlikely to change when the final numbers are out later this year.

Julie Taylor is the new CEO of Alaska Regional. She says her hospital’s poor score is due in part to an increase in post surgical blood clots — seven total — during the year the Medicare data was pulled from.

“If you look at the percent of our total surgeries, this number isn’t alarming. But if it’s my mom, that number is alarming, even one,” Taylor said.

Alaska Regional has emphasized training to bring down the rate of blood clots and other complications, she says, which is especially important given a staff turnover rate of 20 percent annually at the hospital:

“What that means to you is that we have to retrain staff who are coming in, make sure they understand all the protocols, because this takes hard wiring. It’s not by happenstance that these things are prevented,” Taylor said, “and that’s why orientation and training and vigilance have to take place.”

Taylor applauds Medicare’s effort to track patient safety and penalize the worst performing hospitals. That’s a point all of the hospitals agree on, including Fairbanks Memorial. Gena Edmiston is chief nursing officer there. She says during the last year, the hospital has had a new focus on patient safety.

“We meet every two weeks, look at every single safety incident in the hospital. We address them and then very consciously look for results,” Edmiston said.

Fairbanks Memorial has seen steep drops in some areas, like central line infections, she says. Other problems, like patient falls, have been harder to address.

All the hospitals pointed out potential problems with the way Medicare measures quality. Alaska Native Medical Center’s Jay Butler chairs the infection control committee there and says his hospital’s poor score flagged one main problem: “The one that really stands out to us is the catheter associated urinary tract infection rate.”

Butler says many of the cases were  from a type of bug that colonizes the urinary tract without causing an infection. Basically something that looks and acts like an infection but isn’t one.  He says the hospital will address how those cases are handled.  He says the way Medicare issues hospital penalties isn’t perfect, but it’s better than nothing.

“We’ve got to track how we’re doing otherwise we have no idea whether or not we’re making progress,” Butler said. “We wouldn’t even know whether or not we’re providing good care.”

Mandsager, from Providence, says the hospital’s goal is zero central line infections, but it’s a challenge:

“I could not have predicted 20 years ago, in the measures that get publicly reported, how close you have to be to perfection otherwise you’re doing poorly comparatively. Do I feel bad about our current performance? Absolutely.”

Mandsager is confident Providence will not be in the same position during the next round of Medicare penalties.

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“I don’t even know how to feel about the whole thing anymore because I can’t even get anyone who has an answer to help,” she says. “It’s just such a lost cause at this point.”

A few things went wrong with Imler’s healthcare.gov application. First, according to the website, she successfully enrolled in a health plan. But her new insurance company, , didn’t have her application. When she called the healthcare.gov hotline number, no one could help her figure out what went wrong. Then she found out the website miscalculated her subsidy amount. She was supposed to receive a monthly subsidy of $366, but the website only let her use $315.

“The subsidy issue is weird,” she says. “If you look at my profile on the website it shows my full subsidy, but it says I’m only using part of it. So they know I’ve got a screwed up subsidy but they don’t know what to do with it. There’s no one directly you can talk to, to say, ‘Hey my subsidy is on there. How do I apply for all of it?'”

It turns out everyone’s subsidy in Alaska was miscalculated. , a benefits consulting group, discovered the error in mid October and suspended enrollments. It took two weeks for the the Health and Human Services Department to resolve the issue. Since then, Enroll Alaska has signed up about 80 people in the marketplace. Chief Operating Officer Tyann Boling says half the people her insurance agents sit down with have tried to navigate healthcare.gov on their own and given up.

“This is not an easy process. I think even if this website was functioning at 100 percent this would not be an easy process,” Boling says. “This is complicated. If you click on one wrong thing, there’s no back buttons, it can be a really, really nasty process to go through.”

Boling is frustrated with the website, but not as frustrated as Lara Imler. After weeks of trying — and failing — to make her application work, Imler wants a break from healthcare.gov.

She never got a packet from her insurance company asking her to pay the first premium. She figures canceling the plan — with the chance to start fresh later — is her best option.

So on a recent morning, she sat down in her living room, with her laptop and a cup of coffee to try to resolve her difficulties—but not without frustration.

“I’ve had to change my password about four times. Oh you know what, I have it written down. I cheated! There it is,” she says.

The site logs Imler in pretty quickly. And after a few clicks she finds her enrollment information:

The application that she finished on Oct. 24 says, “status, complete.” Imler clicks on the actual application and scrolls down to  an ominous looking red icon that says, “terminate coverage.”

“So you hit the terminate button. It says you’ve chosen to end the following coverage. … You then have to check ‘I have fully read and understand that I’m choosing to terminate coverage,'” she says. “Then you click terminate again and we’ll see what happens.”

What happens is nothing. The health plan Imler signed up for is still listed in her profile. She logs out and then back in, and it looks exactly the same. She checks her e-mail for a notice of coverage termination and finds nothing there either. Imler leans back on the couch and looks surprisingly calm about the whole thing:

“I’m resigned to the fact that it doesn’t work. No matter what I do, it just doesn’t work. And this is the improved website.”

When she is able to cancel her plan, Imler says she won’t be quitting healthcare.gov for good. This is a separation, not a divorce. Imler’s been uninsured for nearly a decade and wants that to change. She plans to log back into the website early next year and is hopeful that signing up for insurance will go a lot more smoothly then.

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Two groups of pediatricians in Anchorage are taking a stand after learning that one of the city’s hospitals, Alaska Regional Hospital, is charging $2,110 for a circumcision, almost 10 times more than the $235 that Providence Hospital, the city’s other major health facility, charges. Those prices are on top of the doctor’s bill.

“We were, I think, shocked by the price we were hearing,” says Dr. Charles Ryan, one of the physicians at . He and his partners no longer perform circumcisions at the 250-bed . Another pediatric practice, , also has stopped most of its circumcisions there. 

Ryan now performs the procedure in his office for $700, the same as he charged in the hospital. He says Alaska Regional is a good hospital but its price for circumcisions is “wildly abnormal.” The hospital provides a small tray of sterilized and reusable instruments for the doctor and a nurse to help take care of the baby during the short procedure.

Kjerstin Lastufka, a spokeswoman for Alaska Regional, says in an e-mail that the cost is based in part on the hospital’s need to be ready to treat medical emergencies. She also points out that insurance companies generally negotiate better rates with the hospital so the average amount that the hospital collects for the procedure is $340. 

Ryan says the doctors in his group had no difficulty deciding to move the circumcisions to their offices. “There was no long discussion,” he says, noting that it took the doctors about two minutes to come to agreement.

“Health care dollars are limited and we like to see them spent in ways that really provide good health care for people and necessary health care for people,” Ryan says. “And when the health care dollar is being milked off by charges … those are dollars that can’t be used for more essential things.”

Yet, even doctors can have difficulty , says , a New Jersey pediatrician who also chairs the American Academy of Pediatrics Committee on Hospital Care. Doctors are speaking up when they think a hospital is charging too much, he says, although most talk to hospital administrators behind closed doors.

“Oh I’m sure there are many private discussions in terms of setting what seems to be reasonable fees,” Percelay adds. “I have not heard of people boycotting services at one hospital based on charges previously.”

Ryan says the incident has convinced him he needs to at least try to be better informed on hospital prices for all kinds of procedures. “Neither hospital is out there trying to put that information right in front of us,” he says. “And sometimes it’s hard information to get if you ask.”

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For the first time, the federal government has publicly what hospitals bill Medicare for the 100 most common diagnoses and treatments.

The information hospitals across the country — and across Alaska — bill dramatically different prices for the same things.

Hospital veteran , the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the on hospital charges as soon as it was out.

“It’s going to create ripples across the nation, really, on pricing,” he says. “It does show some pretty big disparities between hospitals.”

For example, , in Anchorage, charges Medicare $46,252 for a patient with heart failure and a major complication. Alaska Native Medical Center, also in Anchorage, charges $20,839.

In both cases, Medicare doesn’t pay anywhere close to the full charge. The government reimburses Regional $13,950 and Alaska Native, $12,935. Private insurance usually pays more than Medicare, but negotiates the amount.

The system doesn’t make much sense, but Davis says more transparency will help:

“For there to be pressure on pricing on the consumer side, the consumer has to understand what it’s going to cost them. And so, I think this is a good report. I think it’s going to force hospitals to address their pricing.”

But Bruce Lamoureux, CEO of the health system, says his hospital will consider changing some prices, down or even up, based on the report:

“There are some instances where our charges for a particular procedure are, in one case, half of a different provider’s, and in a different case, twice a different provider.”

Lamoureux thinks the information actually gives consumers some negotiating power when it comes to health care costs, something they’ve never had before. He says the system of hospital pricing and reimbursement is badly broken and this step toward more transparency is long overdue.

But a hospital bill is only one part of the overall health care cost picture.

“That’s kind of like a rack rate in the hotel room,” says Karen Perdue, president of the . “Most people aren’t paying that one rate in the hotel. Different payers are demanding different deals at the hospital, so I think what consumers need is not only a more accurate way to determine what their costs are going to be, but also what the full cost will be, not just the hospital cost.”

Like the charges from doctors and anesthesiologists, which aren’t included on a hospital bill. Perdue says her board is looking at ways to make hospital cost data easily available to consumers. But health care is a complicated industry and it’s not an easy task.

“Transparency, for us, feels like the future and where we should be going, and where we should be putting our effort,” she says. “How we should do that in a way that is meaningful to the consumer is the challenge ahead of us.”

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Alaska Natives are twice as likely to get colon cancer and die from the disease than the white population in the United States. When Mayo Clinic doctor took a trip to in the mid-1990’s that startling statistic caught his attention.

“Here they had one of the world’s highest rates of colon cancer and one of the world’s poorest outcomes in terms of survival from cancer – because of late diagnosis,” Ahlquist said.

The best way to prevent colon cancer is through screening, but Ahlquist realized that approach has flaws in rural Alaska. Colonoscopy equipment isn’t available in remote Native villages. A widely-used test that detects blood in stool isn’t effective because many Alaska Natives have a stomach bacteria called that also causes bleeding.  The colon cancer screening rate for Alaska Natives in some rural areas of the state is as low as 23 percent. In urban areas, it’s closer to 60 percent.

So Ahlquist began working on a test that can identify several altered genes that are present in colon cancer.

“It measures DNA changes that are shed from the surface of cancer or pre cancer into the stool and we can detect those changes that act as a signature as the presence of cancer or polyps,” he explains.

The test is expected to cost about $300, far less than the average colonoscopy in Alaska. Ahlquist compares his research to the advent of the pap smear.

“The pap smear took a target, cervical cancer, which at that time, in the ’50’s was the number one cancer killer in women in the United States. Now, it’s essentially been eradicated in women who are screened,” Ahlquist said.

According to published this year, the DNA colon cancer test finds 85 percent of colon cancers and . Ahlquist and the Mayo Clinic are working with a company called to commercially develop the test, and both will benefit financially if it comes on the market.

, at the Huntsman Cancer Institute in Utah, has high hopes, too.  “In the end, it could be a huge game changer.”

But Burt thinks it has to get better at detecting pre-cancerous polyps.

“Is it enough to replace colonoscopies so we only do colonscopies on people with a positive stool test? Probably not yet. But it’s getting there,” he says.

of the Fred Hutchinson Cancer Research Center in Seattle agrees that with more rigorous study, these tests could change cancer diagnosis and treatment.  He is working on another version of a DNA-based stool test for colon cancer detection.   DNA tests are also in the works for a long list of cancers including, lung, pancreatic and brain cancer.

“It’s very exciting, I think we’re going to really see a revolution in the way we take care of patients who have cancer.”

In Alaska, the Alaska Native Tribal Health Consortium began a three year trial of Ahlquist’s colon cancer DNA test. A hundred patients have enrolled.

If the FDA grants approval, the test could be available as soon as the middle of next year.

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Three years ago, he worked in this remote arctic community, which is home to 3,000 people, mostly Inupiat Eskimos. Cooper occasionally saw patients complaining of a persistent cough. They may also have been experiencing night sweats or weight loss — classic signs of tuberculosis. But, he says, “TB was rarely on my list of diagnoses when I would see a patient. I hate to admit that. And as I look back now, I go through these patients some nights and I think, that patient could have had TB, and why didn’t I at least do this? Why wasn’t I even aware of it?”

Last July, Cooper came to Anchorage for a position with Alaska’s Health Department. His new job: to lower the state’s  — in 2011, the highest rate in the United States.

Cooper is learning from his mistakes. He’s focusing part of his efforts on educating other doctors and nurses in Alaska about tuberculosis. That starts with explaining why the TB rate is so high.

“We experienced probably the highest rates of TB back in the early 20th century found anywhere in the world at the time,” he says. Many Alaska Natives were living in crowded conditions that allowed TB to spread easily.

“Imagine a nice cold winter and a packed house full of people. And one person having picked up this brand new disease that they have no immunity against. And then spreading it. It just can spread like wildfire.”

Until 1950, TB was the No. 1 cause of death in Alaska. That legacy means that a large number of Alaskans still carry the bacteria that can cause the disease. They have no symptoms, and they aren’t contagious, but full-blown TB can flare up at anytime and then spread.

One of the nurses Cooper works with is Karen Martinek. She’s part of a team that responds quickly when a new case pops up.

“If we see a small, isolated village — usually, they are accessible only by air or snow machine in the winter — and we have a case or two of active tuberculosis identified in that village, we can be quite confident that there’s transmission going on,” she says.

The treatment for active TB is a long course of powerful drugs. For people with inactive TB, there is a  of drugs that is much less complicated and eliminates TB. Cooper hopes that will encourage more people with latent disease to complete the treatment, which would eventually help bring down the high rate of active TB in Alaska. Until then, Cooper worries about the potential for epidemics in the state.

Cooper and others are also worried about strains of TB that are resistant to many of the available drugs. But so far, so-called multidrug-resistant TB is not widespread here. And the overall rate of TB in Alaska over the past 20 years has been on a .

Cooper hopes he can keep that trend going. With a sheepish smile, he says that will involve making sure more doctors in Alaska think about the possibility of TB when each new patient walks through their clinic door.

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“If they were to have an abnormal rhythm we could see it right away and alert the bedside nurse,” Lynch explains, as she examines one patient’s data.

Lynch is at the heart of hospital’s electronic intensive care unit. In Alaska, where it can be hundreds of miles to a hospital with an intensive care unit, the Anchorage hospital is trying to electronically bridge the gap.  The allows staff in Anchorage to help treat patients at three other hospitals in remote locations, while also adding an extra layer of care for patients in the Anchorage ICU.

So Lynch functions as an extra set of eyes for the bedside nurse. She is constantly monitoring the patients’ breathing rate, blood pressure and oxygen level. She can see the patients too, with a camera that allows her to zoom in or out and pan around the room.

“I was watching somebody,” Lynch says. “She’s behind the curtain right now, but I’m just keeping an eye on her for the bedside nurse, who’s afraid she might try to leave.”

The picture is sharp enough for Lynch to see pupil responses or assess the tubes that keep many ICU patients alive. She could monitor as many as 33 patients from this one station. But on a typical day, Lynch is watching about two dozen.  

Cecilee Ruesch, clinical manager of the Providence eICU, says the concept is really pretty simple. 

“You take some 21st century technology and apply some expertise behind it and you can provide additional support for the patients and the staff working at the bedside,” Ruesch says.  

During the day, the eICU nurse is alone at the station. But for 10 hours each night, a doctor works there too. That’s important because in the past, ICU nurses would have to call a sleeping doctor to ask a question or request an order. Ruesch says nurses were reluctant to do that. Now problems that crop up can be dealt with right away.

“Now, because we have the physician who’s awake, there’s not that ‘I’m going to wait just a little bit to call the physician.’ They’re calling and getting the order right away,” Ruesch explains.

Providence started the electronic ICU three years ago. In 2010, they began using the system to monitor beds at remote hospitals. It costs Providence $2 million a year to operate the system and the rural hospitals pay about $40,000 dollars a year to hook each bed up to the system.

was the first to come on board, with two beds. Bonnie Neff is the patient care nurse manager in Kodiak. She praises the extra support the eICU provdes.

“It’s awesome,” says Neff. “[For] anybody that lives in a rural community, having the eICU is a huge asset.”

The Kodiak hospital only uses the eICU about six times a month on average, Neff says. But during those times, it’s extremely valuable. She describes a typical scenario.

“They’re on our floor, we’re stabilizing them, [and then] the weather turns bad,” says Neff. “We can’t get them to Anchorage because nobody’s flying.”

Neff says the eICU staff provides guidance on tricky — and often lifesaving — procedures. Since the system first started a year and a half ago, she estimates the eICU has prevented about 17 patients from being transported to Anchorage. She says a typical medevac costs $20,000. And for the patients, the benefits are just as huge, says eICU clinical manager Ruesch.

“That’s 17 patients got to stay with their families, got to stay in their own community. And what a benefit that is for them,” Ruesch notes.

Critics of the eICU say the concept costs a lot of money and hasn’t yet proven it can improve patient care. But a 2011 study in the Journal of the American Medical Association found eICUs prevent deaths by helping doctors follow best clinical practices. The study also showed eICUs cut two days off the average length of an ICU stay. 

According to Ruesch, the Providence eICU is sending patients home close to a day early.

“Working together we’re trying to improve that even more, having people come off the ventilators quicker because if they can come off the ventilators quicker, they can leave the ICU quicker and so we’re really working together as a collaborative team to improve, ongoing what we can do for our patients,” Ruesch says.

Besides Kodiak, the Anchorage eICU is now monitoring patients at in Juneau. A Providence hospital on the Oregon coast called Seaside also joined the system because bad weather can leave critically ill patients stranded there.  Providence is hoping more rural hospitals will follow.

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