title: Estimated savings from paid telephone consultations between subspecialists and primary care physicians.
abstract: OBJECTIVE
  Pediatric subspecialists are not routinely reimbursed by Medicaid or insurance payers for telephone consultations. Generally, access to pediatric subspecialists is limited because of the small number of providers, their concentration in academic medical centers, and increasing demand for their services. Little is known about the nature of such consults, the time required to provide them, or whether there is a positive economic impact for payers.
  
  
  METHODS
  Between March and October of 2007, pediatric subspecialists from 6 academic medical centers in North Carolina completed consultation reimbursement-request forms to prospectively track their telephone consultations with primary care physicians for the care of Medicaid patients<22 years of age. Data collected included the amount of time required per consult and consult outcomes in terms of service use and quality of care. Medicaid claims records and primary care physician surveys were used to validate the pediatric subspecialist consultation outcomes.
  
  
  RESULTS
  A total of 47 pediatric subspecialists provided 306 consults regarding the care of 292 Medicaid-insured children over the 8 study months. Telephone consults were generally <15 minutes in length and exceeded 30 minutes in <7% of calls. Pediatric subspecialists reported that telephone consults led to avoidance of specialist visits (n=98), hospital transfers (n=35), hospital admissions (n=14), and emergency department visits (n=14). Medicaid claims data supported these reports; matched primary care physician surveys suggested even higher levels of service avoidance. After adjusting for the reimbursed costs of providing telephone consults, an estimated $477274 was saved ($39 per dollar spent).
  
  
  CONCLUSIONS
  Telephone consultations with pediatric subspecialists provide a valuable service to primary care physicians providing medical homes to Medicaid patients. Rewarding physicians for telephone consults seems to be cost-effective because of reduced use of costly services and reported improvements in quality of care.
authors.affiliation: AccessCare, 3500 Gateway Centre Blvd, Suite 130, Morrisville, NC 27560, USA. swegner@ncaccesscare.org
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wegner
authors.forename: Charles G
authors.initials: CG
authors.lastname: Humble
authors.forename: John
authors.initials: J
authors.lastname: Feaganes
authors.forename: Alan D
authors.initials: AD
authors.lastname: Stiles
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D008297:Male; D008484:Medicaid / Q000191:economics*; D009657:North Carolina; D010372:Pediatrics / Q000191:economics* / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms; D013685:Telecommunications / Q000191:economics / Q000706:statistics & numerical data; D013689:Telephone / Q000191:economics*; D014481:United States