title: The complexity, relative value, and financial worth of curbside consultations in an academic infectious diseases unit.
abstract: BACKGROUND
  Curbside consultations are common in clinical practice. The complexity, relative value, and revenue loss associated with curbside consultations are not well defined.
  
  
  METHODS
  Curbside consultations performed during a 1-year period were studied. Each curbside consultation was assigned a Current Procedural Terminology (CPT) code on the basis of the inpatient versus outpatient status of the patient, initial versus subsequent care, and clinical complexity. On the basis of the CPT code, the physician work component of the relative value unit (wRVU) was assigned for each curbside consultation. The 2005 Centers for Medicaid and Medicare Services conversion factor of $37.89 per wRVU was used for cost estimates. Comparisons were made with formal consultations performed during the same time period.
  
  
  RESULTS
  A total of 1001 curbside consultations were fielded: 66% involved outpatients, and 97% were coded as initial consultations. A total of 78% of curbside consultations were considered complex in nature, being assigned a CPT code of level 4-5, including 84% of the inpatient and 75% of the outpatient curbside consultations. These curbside consultations would have generated 2480 wRVUs. During the same period, formal consultations generated 12,121 wRVUs. Thus, curbside consultations represented 17% (2480/14,601) of the clinical work value of the infectious diseases unit. If the infectious diseases unit had performed these curbside consultations as formal consultations, an additional $93,979 in revenue would have been generated.
  
  
  CONCLUSIONS
  Curbside consultations are common and complex. The curbside consultation should be incorporated into measures of infectious diseases providers' productivity and compensation.
authors.affiliation: University of Vermont College of Medicine and 2Fletcher Allen Health Care, Burlington, Vermont 05401, USA. christopher.grace@vtmednet.org
authors.forename: Christopher
authors.initials: C
authors.lastname: Grace
authors.forename: W Kemper
authors.initials: WK
authors.lastname: Alston
authors.forename: Mary
authors.initials: M
authors.lastname: Ramundo
authors.forename: Louis
authors.initials: L
authors.lastname: Polish
authors.forename: Beth
authors.initials: B
authors.lastname: Kirkpatrick
authors.forename: Christopher
authors.initials: C
authors.lastname: Huston
mesh_terms: D003141:Communicable Diseases / Q000628:therapy*; D039702:Current Procedural Terminology; D006302:Health Services Research; D006801:Humans; D005791:Patient Care / Q000191:economics* / Q000379:methods*; D010820:Physicians; D012017:Referral and Consultation / Q000191:economics* / Q000458:organization & administration*; D014481:United States