Andino Juan J, Castaneda Peris R, Shah Parth K, Ellimoottil Chad
Department of Urology, Michigan Medicine.
University of Michigan Medical School.
Urol Pract. 2021 Jan;8(1):53-57. doi: 10.1097/upj.0000000000000149. Epub 2020 Jan 20.
Telehealth is gaining more attention in multiple specialties, including urology. Video visits in particular have shown high satisfaction and cost-saving for patients. However, there has been little investigation into how video visits compare to traditional clinic visits on measures of clinical efficiency and reimbursement.
Our dataset included 250 video visits of established patients at Michigan Medicine Department of Urology and 250 in-person clinic visits with the same providers completed between July 2016 and July 2017. Information on visit completion and cancellation rates; cycle time (time from check in to check out); reimbursement; and patient out-of-pocket expenses was collected using the electronic medical record and billing data.
Completion rates were similar between video and clinic visits (58% versus 61%, respectively; p=0.24). Average cycle time for video visits was significantly shorter compared to clinic visits (24 min vs 80 min, respectively; p<0.01). Neither average commercial payer reimbursement (p=0.21) nor average out-of-pocket expense (p=0.22) was statistically different between video and traditional visits. More video visits than clinic visits were billed as level 3 encounters (85% and 63%, respectively, p=0.002).
Our study demonstrates that video visits have the potential to reduce the time patients spend on follow-up care without negatively impacting reimbursement rates. However, these visits could reduce average billing levels. These findings suggest that the incorporation of video visits into practice may be more efficient for patients but may also reduce billing levels.
远程医疗在包括泌尿外科在内的多个专科中受到越来越多的关注。特别是视频问诊已显示出患者满意度高且节省费用。然而，关于视频问诊与传统门诊在临床效率和报销方面的比较，几乎没有研究。
我们的数据集包括密歇根大学医学部泌尿外科250例复诊患者的视频问诊以及250例由相同医护人员进行的面对面门诊问诊，这些问诊在2016年7月至2017年7月期间完成。使用电子病历和计费数据收集了有关问诊完成率和取消率、周期时间（从登记到结账的时间）、报销以及患者自付费用的信息。
视频问诊和门诊问诊的完成率相似（分别为58%和61%；p = 0.24）。视频问诊的平均周期时间明显短于门诊问诊（分别为24分钟和80分钟；p < 0.01）。视频问诊和传统问诊之间的平均商业医保报销（p = 0.21）和平均自付费用（p = 0.22）在统计学上均无差异。被列为3级诊疗的视频问诊比门诊问诊更多（分别为85%和63%，p = 0.002）。
我们的研究表明，视频问诊有可能减少患者在后续护理上花费的时间，而不会对报销率产生负面影响。然而，这些问诊可能会降低平均计费水平。这些发现表明，将视频问诊纳入临床实践对患者可能更高效，但也可能降低计费水平。
