Transcript Reimbursement Program for Curbside Consults for Medicaid

Estimated Savings from Paid Telephone
Consultations Between Pediatric SubSpecialists & Primary Care Physicians
Alan D. Stiles, MD; Charles G. Humble, PhD;
John Feaganes, DrPH; Steven E. Wegner, MD, JD
AccessCare
Morrisville, North Carolina, USA
2008 Pediatric Academic Societies & Asian Society for Pediatric Research
Joint Meeting
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Background


Access to pediatric sub-specialists often delayed

Limited supply of sub-specialists

Concentrated in academic medical centers

Increased demand for sub-specialty care
Informal telephone consults help fill gaps in care

Little is known of nature and effectiveness
2
Methods

Grant funding to underwrite costs from NC Foundation for
Advanced Health Programs, Inc.

Clinic for Program was selected by Chief of Pediatrics at each
Medical Center


Data collected re Time Required and Outcomes of Call


4 of 6 Centers chose Infectious Disease
Services avoided, Improved Quality of Care
Total of 464 sub-specialist consults paid

Results from final 306 described here

Costs based on average costs per service at North Carolina
Children’s Hospital

Validation of results using Claims data and PCP surveys
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Time Required to Complete
70
60
Per cent
50
40
30
20
10
0
< 15 M inute
15 to 30
>30 M inutes
306 Consults, March – October 2007
4
Results of Telephone Consults
Improved Quality and Avoided Services
180
163
160
140
120
98
100
N
80
60
35
40
20
14
14
Hospital admission
ED visit
0
Improved Quality
Specialist visit
Hospital transfer
306 Consults, March – October 2007
5
Estimated Costs Avoided
Sub-Specialist Data
Value of 161 services described as
avoided = $477,254*
 Costs = $12,240 if paying
$40/Consult
 $39 saved/dollar spent

* Averages
-
charges for Medicaid kids at UNC in 2006 calculated for:
ED Visits (both Emergent & Non-Emergent)
Specialist visits (CPT 99242 – 99245)
Hospitalizations included Room & board, Physician charges, and Lab/Drug/DME
(Admissions beginning in 1st week of life excluded)
6
Validation Method #1

Verify that services which sub-specialists
report as avoided do not have claims filed

Analyses show 1 claim for Sub-Specialist
Consultation in pre-defined windows of time.

No other claims for “avoided services” in
pre-defined windows
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Validation Method #1

Survey to PCPs who originally initiated consults

Gold standard for outcomes of the consults

NOT told outcomes reported by Sub-specialists


Response rate 65%
PCPs reported substantially higher numbers of
avoided services (especially true for avoided
transfers, hospitalizations and ED visits)
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Validation Method #2
Estimated Savings from Sub-Specialist Reports
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Validation Method #2: PCP Savings
Specialist
PCP
200
180
Avoided Services
160
140
120
100
80
60
40
20
0
Specialist visit
Hospital transfer
Sub-Specialist: $477,254
Hospitalization
ED visit
PCP: $1,632,430
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Validation Method #2
Estimated Services Avoided from Matched Reports*
57
60
50
40
33
33
N 30
23
20
20
13
10
6
2
0
Specialist visit
Hospital transfer
Hospital admission
Subspecialist
ED visit
PCP
* Based on 130 matched pairs
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Conclusions

Telephone consults lead to:



Improved Quality of Care
Decreased use of unneeded medical services
Reduced costs for Medicaid for patients

Tests of savings among more sub-specialties
are needed.

Underwriting of costs by private payers
should be encouraged.
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References
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References (continued)
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