Transaction Cost Analysis of In-Clinic Versus Telehealth Consultations for Chronic Pain: Preliminary Evidence for Rapid and Affordable Access to Interdisciplinary Collaborative Consultation

Abstract

Objectives With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Methods Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Results Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. Conclusions U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.

A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities

“…Specialities represented by less than three papers in total (n=11) were grouped under 'others' in Table 4. These included the following specialities: Hematology, Otolaryngology, General Medicine, Geriatric, Nephrology, Obstetrics, and Orthopaedics (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

“…Simple cost analysis was used by (n=14) (52,(63)(64)(65)(66)(67)(70)(71)(72)(73)(74)(75)(76)(77) studies measuring the cost avoidance, cost saving and added revenue. While (n=15) (27,30,35,58,68,69,(78)(79)(80)(81)(82)(83)(84)(85)(86) studies conducted a cost minimization analysis as a method to assess the economic benefits of telemedicine. The cost of providing telemedicine services was compared to the cost of providing the same healthcare service in a conventional face-to-face manner, whether it was a hospital based visit where the patient travels to get the service, or an outreach clinic where the provider travels to provide the care.…”

Development and Patient Satisfaction of a New Telemedicine Service for Pain Management at Massachusetts General Hospital to the Island of Martha’s Vineyard

“…For example, the Specialty Care Access Network-ECHO pain management program (SCAN-ECHO-PM) provided primary care providers with case-based pain management specialist consultation that led to increased utilization of physical medicine services and initiation of nonopioid analgesics for patients in the Veterans Health Administration [18]. Another study demonstrated rapid and cost-effective access of telehealth consultation visits between primary care providers in Washington State and a team of pain medicine specialists compared with 'in-clinic visits,' as it pertains to transaction cost analysis [19]. In our study, the quality of care was maintained via direct videoconferences with patients and pain specialists, physical exams performed by appropriately trained nursing staff, and monthly physician visits to the island for procedural interventions.…”

Optimizing telehealth pain care after COVID-19

“…The value of pain management telementoring programs is supported by several studies, with demonstrations of increased provider knowledge and/or confidence, 2 , 5 , 31 , 53 , 67 improved communication between patients and providers, 5 , 17 greater guideline adherence, 2 and cost benefits relative to specialty clinic visits. 85 Systemic changes (eg, leadership buy-in and modified clinic schedules) that increase the feasibility of regular participation in telementoring may be necessary. 29 , 75 Another E-learning approach for providing structured training and mentored practice of psychologically informed methods for providers to enhance pain self-management by patients with chronic pain involves online webinar-style interactive sessions with skills practice required between sessions.…”