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Pediatric subspecialty telephone consultations may be cost-saving for Medicaid, research reveals

Wednesday, January 14 2009 | Comments
Evidence Grade 0 What's This?
Telephone consultations between primary care physicians and pediatric subspecialists regarding young Medicaid patients may lead to reduced use of costly services and overall cost savings, a new study demonstrates.

Researchers reviewed consultation reimbursement-request forms for telephone consultations that took place in a pilot program from March to October 2007. The phone calls were made between 47 pediatric subspecialists from six North Carolina academic medical centers and primary care physicians regarding the care of 292 Medicaid patients aged younger than 22 years (mean age, 4.3 years).

The consultations, during which the physicians informally discussed diagnosis and treatment of the patients, lasted less than 15 minutes in most cases, although in a few cases, the calls lasted more than 30 minutes. Most commonly, primary care physicians called subspecialty physicians for advice regarding management of a new or existing problem. The subspecialists received $40 to provide the consultation.

Results showed that the 306 consultations led to 98 avoided specialist visits, 35 avoided hospital transfers, 14 avoided hospital admissions and 14 avoided visits to the emergency department. Medicaid claims records supported these reports, while primary care physician validation surveys suggested even higher levels of service avoidance.

Furthermore, the researchers considered the average cost of services in Medicaid (e.g., $8,352 for hospitalizations) and applied these to the services avoided, finding an estimated total savings from the consultations of $477,254. After reducing the estimated savings by the cost of the consultations, $39 was saved per dollar spent on consultations.

In addition to reducing the costs for Medicaid patient care, the researchers noted the potential savings to patients and families (e.g., gas, travel, time off from work) that were linked with avoiding unneeded subspecialty care.

"In the U.S. health care system, where current rates of increase in costs are unsustainable, finding ways to contain costs of care for the patients, as well as the providers and insurers, will provide great benefit to the overall system," the study authors wrote.

The results of the study were published in the December issue of the journal Pediatrics.

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