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1 Estimated Savings from Paid Telephone Consultations Between Pediatric Sub- Specialists & Primary Care Physicians Alan D. Stiles, MD; Charles G. Humble,

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Presentation on theme: "1 Estimated Savings from Paid Telephone Consultations Between Pediatric Sub- Specialists & Primary Care Physicians Alan D. Stiles, MD; Charles G. Humble,"— Presentation transcript:

1 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 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 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 Children’s Hospital Validation of results using Claims data and PCP surveys

4 4 Time Required to Complete 306 Consults, March – October 2007

5 5 Results of Telephone Consults Improved Quality and Avoided Services 306 Consults, March – October 2007

6 6 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 – 99245) - Hospitalizations included Room & board, Physician charges, and Lab/Drug/DME (Admissions beginning in 1 st week of life excluded)

7 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 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 9 Validation Method #2 Estimated Savings from Sub-Specialist Reports

10 10 Validation Method #2: PCP Savings

11 11 Validation Method #2 Estimated Services Avoided from Matched Reports* * Based on 130 matched pairs

12 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 13 References Jewett EA, Anderson MR, Gilchrist GS. The pediatric subspecialty workforce: public policy and forces for change. Pediatrics 2005;116(5): Workforce Data: American Board of Pediatrics, 2006 – 2007[monograph available at ]. American Board of Pediatrics. Chapel Hill: ABP; 2006 Expert Workgroup on Pediatric Subspecialty Care. Recommendations for Improving Access to Pediatric Subspecialty Care Through the Medical Home. Washington, DC: Maternal and Child Health Policy Research Center, forthcoming Keating KL et al. Physicians’ experiences and beliefs regarding informal consultation. JAMA 1998;280; Kuo D, Gifford DR, Stein MD. Curbside consultation practices and attitudes among PCP and medical subspecialists. JAMA 1998;280; Stille CJ, Primack WA, Savageau JA. Generalist-subspecialist communication for children with chronic conditions. Pediatrics 2003;112: Rushakoff RJ, Woeber KA. Evaluation of a “formal” endocrinology curbside consultation service: advice by means of internet, fax, and telephone. Endocrinology Pract 2003;9 (2): Yanovski SZ, Brown RL, Balaban DJ, Yanovski JA, Malley JD. Telephone triage by primary care physicians. Pediatrics 1992; 89: Golub RM. Curbside consultation and the viaduct effect. JAMA 1998;280;

14 14 References (continued) Berlin L. Curbside consultations. Am J Roentgenology 2002;178: Cotton MF. Telephone calls to an infectious disease fellow. Pediatrics 1995; 95: Leblebicioglu H, Akbulut A, Ulusoy M, Sunbul M, Aydin K, Geyik, et al. Informal consultations in infectious diseases and clinical microbiology practice. Clin Microbiol Infect 2003;9: Borowitz SM, Wyatt JC. The origin, content, & workload of consultations. JAMA 1998;280; Chatterjee A, Lackey SJ. Prospective study of telephone consultation and communication in pediatric infectious diseases. Pediatr Infect Dis J 2001;20: American College of Physicians. A System in Need of Change: Restructuring Payment Policies to Support Patient-Centered Care. Philadelphia: American College of Physicians; 2006: Position Paper. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106) Patient Centered Primary Care Collaborative. Physician Payment Reform: A New Payment System to Support Higher Quality, Lower Cost Care Through a Patient-Centered Medical Home. Accessed January 25, 2008; payment-reformhttp://www.pcpcc.net/content/physician- payment-reform Gruskin A, Williams et al. FOPE II. Pediatrics 2000;106: Diamond C. Access to specialty care [letter]. NEJM 1995:332 (7):


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