Effects of telemedicine triage on efficiency and cost-effectiveness in spinal care.

Abstract

Ambulatory spine referral triage must be optimized to improve both quality of care and access to specialists. To evaluate cost savings in an existing model of telemedicine/electronic-triage for ambulatory spine referrals. Retrospective review. Institutional spine center. All patients/referrals made to the institutional spine center of a tertiary medical center from 2011 to 2014 were included in the data analysis. Cost savings and efficiency was evaluated based upon intake to appointment time, rate of referral to surgeons versus nonoperative providers, additional testing required, and extrapolated cost savings based on estimated avoidance of unnecessary office visits and travel. All ambulatory spine referrals electronically triaged (E-triaged) from 2011 to 2014 were analyzed. The E-triage database was mined for data from intake until triage completion. Hospital electronic medical record system was mined for data on initial clinic visit, tests ordered, follow-up appointments, and presence of surgical encounters. Financial savings from avoiding unnecessary visits were estimated. There were 16,174 records created from 2011 to 2014, of which 10,832 were E-triaged by spine surgeons. E-triage generated 3,718 nonoperative provider visits within our healthcare system. The "saved" surgical consult that was avoided resulted in total estimated savings of $793,835 to the patient population; 4,446 patients were deemed surgical and were offered appointments with a spine surgeon. Appropriate triage of ambulatory spine referrals improves access and quality of care. E-triage resulted in $800,000 cost savings. Further studies are required to fully evaluate the effects of an E-triage system on ambulatory spinal care.