Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

Abstract

Objective: To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization.

Methods: The Optum proprietary claims dataset (2010-2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third--party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.

Results: For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD).

Conclusion: Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization.

Figure 1. Episode treatment groups (ETGs) (bar height) and percentage neurologist involvement (top of bars) for 10 neurologic conditions

*Involvement defined as ambulatory care for all conditions except acute stroke, where inpatient neurologist care was defined as involvement. **Acute stroke defined as having an inpatient stay with a discharge diagnosis-related group for stroke in a calendar year.

Figure 2. Average annual episode treatment group (ETG) costs (allowed third-party payments, in 2012 US dollars) by neurologist involvement

Figure 3. Adverse events and health care utilization metrics, and association with neurologist ambulatory care, by condition

*Epilepsy has 2 severity levels; total episode treatment groups (ETGs) depicted here for epilepsy are emergency visits. CI = confidence interval; ED = emergency department; OR = odds ratio.

Figure 4. Disease-specific therapeutics and related screening metrics, by condition

*For episode treatment groups (ETGs) with included pharmacy insurance benefit. **Immunotherapies not including steroid treatments. CI = confidence interval; OR = odds ratio; OT = occupational therapy; PT = physical therapy.