Financial implications of telemedicine visits in an academic endocrine surgery program

Abstract

Background: Telemedicine is an emerging medium for the delivery of ambulatory care, but the reimbursement profile of telemedicine visits in the surgical setting has not been well studied. Methods: A retrospective assessment of telemedicine encounters for thyroid and parathyroid conditions occurring from April 2015 to April 2017 was performed. Financial reimbursement from commercial payers for new and established patient visits were compared between telemedicine visits and in-person visits. Patient "savings" in terms of travel distance and drive time were calculated. Results: A total of 290 telemedicine encounters were conducted; 7% were initial consultations, 47% were postoperative visits, and 45% were follow-up visits. The median patient age was 57 years. The median round-trip travel distance saved was 123.6 miles with estimated drive time of 2.4 hours per encounter. In 2% of cases, a second in-person visit within the 90-day global period occurred after a postoperative telemedicine encounter. Charges were filed for 67 encounters. The initial unpaid claims rate was 6%, which was consistent with the unpaid claims rate for in-person visits. The charge-to-collection ratio was comparable to that of in-person visits. There was a higher ratio of level 2 visits in the telemedicine encounters. Over the study period, 70 clinic hours were liberated via the use of telemedicine. Conclusion: Endocrine surgery telemedicine visits have the same level for level reimbursement profile as in-person visits. Down-coding and elimination of components of in-office physical examinations may lead to modest decreases in overall reimbursement. Other advantages include reallocation of clinic resources and decreased travel burden for patients.

Development, Implementation, and Evaluation of a Telemedicine Preoperative Evaluation Initiative at a Major Academic Medical Center

“…The methods were used and reported in previous literature involving telemedicine. 19 In our patient cohort, 14 zip codes were not entered into the EMR; hence, our time savings analysis was based on 405 subjects. We estimated the travel time with traffic by assuming morning telemedicine encounters occurring at 10 am and afternoon encounters beginning at 1 pm .…”

Evaluating the patient experience with urological video visits at an academic medical center

“…First, video visits eliminate or reduce patients' time spent waiting to see their doctors (2)(3)(4). Video visits also eliminate travel time for patients (5,6). Finally, video visits may reduce caretaker burden.…”

Endocrine Surgery during the COVID-19 Pandemic: Recommendations from Endocrine Surgery Society of Turkey

“…[93,94] However, before implementing the telemedicine program, issues regarding patient privacy, financial reimbursement and technological platforms' reliability should be considered. [95] Previous studies have demonstrated the applicability of telemedicine in a wide range of applications, from diabetic retinopathy screening to postoperative visits for pediatric urology. Surgical procedures, such as inguinal or umbilical hernia repair, have been found to be particularly suitable for telemedicine encounters since these operations are associated with relatively lower complications that require faceto-face evaluation or intervention.…”