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The Effect of Pre-appointment Consult Triage on Patient Selection and Revenue Generation in a University Rheumatology Practice

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West SG1, Pearson DW1, Striebich CC1, Goecker R1, Kolfenbach JR1. Arthritis Care Res (Hoboken). 2018 Jul 12. doi: 10.1002/acr.23701. [Epub ahead of print]

Abstract

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1 University of Colorado Denver.

Abstract

OBJECTIVE: To evaluate the effectiveness of pre-appointment consult screening to identify patients with autoimmune and inflammatory rheumatic diseases (AIRD) and to evaluate the revenue implications of routine outpatient care of AIRD patients compared to non-AIRD patients.

METHODS: Using data recorded in the electronic medical record, all new outpatient rheumatology consults sent during a 9 month period were retrospectively analyzed for final diagnosis and revenue generation for routine outpatient care over one year following consult review or initial evaluation.

RESULTS: A total of 961 consults were received and underwent pre-appointment triage. Overall, 673 consults were approved for AIRD evaluation and 288 consults were declined to be seen. Patients were seen an average of 13 days after consult review. Of approved consults, 597 came for evaluation with 357 diagnosed as having an AIRD and 240 with a non-AIRD. Of the declined consults, 128 had one year followup data with 6 patients eventually diagnosed as having an AIRD (consult triage sensitivity 98%, positive predictive value 60%). The consult triage system allowed more AIRD patients to be seen over a one year period. Revenue data for outpatient care was available for 318/357 AIRD patient and 192/240 non-AIRD patients showing that care of AIRD patients generates 44 times more revenue compared to non-AIRD patients ($5877/AIRD pt vs $134/non-AIRD pt, p< 0.001).

CONCLUSION: Pre-appointment consult screening is an effective method to identify patients with an AIRD. This enables timely access to care for patients with the highest need of evaluation and results in significantly more revenue generation.