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 Children’s 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 #2Estimated Savings from Sub-Specialist Reports

10. Validation Method #2: PCP Savings

11. Validation Method #2Estimated 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.

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