Estimated Savings from Paid Telephone Consultations Between Pediatric Sub-Specialists & Primary Care Physicians

1
Estimated Savings from Paid Telephone
Consultations Between Pediatric Sub-Specialists
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

2
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

3
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
• 4 of 6 Centers chose Infectious Disease
• Data collected re Time Required and Outcomes of
  Call
• 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 Childrens Hospital
• Validation of results using Claims data and PCP
  surveys

4
Time Required to Complete
306 Consults, March October 2007
5
Results of Telephone ConsultsImproved Quality
and Avoided Services
306 Consults, March October 2007
6
Estimated Costs AvoidedSub-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)

7
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

8
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)

9
Validation Method 2 Estimated Savings from
Sub-Specialist Reports
10
Validation Method 2 PCP Savings
11
Validation Method 2 Estimated Services Avoided
from Matched Reports
Based on 130 matched pairs
12
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.

13
References

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References (continued)

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