Cost-savings analysis of telemedicine use for ophthalmic screening in a rural Appalachian health clinic.

Life in mountainous, rural areas poses unique obstacles for ophthalmic care--notably, a lack of access to ophthalmologists and cost of care. Using telemedicine as a screening tool addresses both issues for diabetic retinopathy (DR) screening, as fundus photography has been determined to be sensitive and specific when screening for DR. The American Diabetes Association places a Grade E recommendation on fundus photography as a screening tool. We analyze the financial impact of ophthalmic telemedicine in a mountainous, rural health clinic in West Virginia over a seven year period from 2003-2009. At-risk patients are screened with a fundus camera during routine clinic visits, and the image is interpreted off-site by an ophthalmologist. Patients are either advised to follow up yearly or receive an immediate opthalmic referral. Considering the number of patients screened, travel costs, work missed, overhead, and billing considerations yields a savings of $153.43 per patient visit.