Portney David S, Ved Rohan, Nikolian Vahagn, Wei Andrea, Buchmueller Tom, Killaly Brad, Alam Hasan B, Ellimoottil Chad
Medical School, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Mhealth. 2020 Oct 5;6:32. doi: 10.21037/mhealth-20-33. eCollection 2020.
Expansion of telehealth is a high-priority strategic initiative for many health systems. Surgical clinics' implementation of video visits has been identified as a way to improve patient and provider experience. However, whether using video visits can reduce the cost of an outpatient visit is unknown.
Prospective case study using time-driven activity-based costing at two outpatient surgical clinics at an academic institution. We conducted stakeholder interviews and in-person observations to map outpatient clinic flow and measure resource utilization of four key steps: check-in, vitals collection and rooming, clinician encounter, and check-out. Finally, we calculated the resource cost for each step using representative salary information to calculate total visit cost.
Video visits did not systematically reduce the amount of time clinicians spent with patients. Mean [standard deviation (SD)] visit costs were as follows: traditional clinic visits, $26.84 ($10.13); physician-led video visits, $27.26 ($9.69); and physician assistant-led video visits, $9.86 ($2.76). There was no significant difference in the total cost associated with physician-led traditional clinic visits and video visits (P=0.89). However, physician assistant-led video visits were significantly lower cost than physician-led video visits (P<0.001).
Using physician-led video visits does not reduce the cost of outpatient surgical visits when compared to traditional clinic visits. However, the use of less expensive clinician resources for video visits (e.g., physician-assistants) may yield cost savings for clinics.
远程医疗的扩展是许多医疗系统的一项高度优先战略举措。外科诊所实施视频问诊已被视为改善患者和医疗服务提供者体验的一种方式。然而，使用视频问诊是否能降低门诊就诊成本尚不清楚。
在一所学术机构的两家门诊外科诊所采用基于时间驱动作业成本法进行前瞻性案例研究。我们进行了利益相关者访谈和实地观察，以梳理门诊流程并衡量四个关键步骤的资源利用情况：登记、生命体征采集与安排就诊、临床医生问诊以及结账。最后，我们使用代表性薪资信息计算每个步骤的资源成本，以得出每次就诊的总成本。
视频问诊并未系统性地减少临床医生与患者相处的时间。平均[标准差（SD）]就诊成本如下：传统门诊就诊为26.84美元（10.13美元）；医生主导的视频问诊为27.26美元（9.69美元）；医师助理主导的视频问诊为9.86美元（2.76美元）。医生主导的传统门诊就诊和视频问诊的总成本无显著差异（P = 0.89）。然而，医师助理主导的视频问诊成本显著低于医生主导的视频问诊（P < 0.001）。
与传统门诊就诊相比，使用医生主导的视频问诊并不能降低门诊外科就诊成本。然而，在视频问诊中使用成本较低的临床医生资源（如医师助理）可能会为诊所节省成本。
