Understanding the cost savings of video visits in outpatient surgical clinics

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Telemedicine; cost analysis; provider costs; telehealth; video visits.

Figure 1

Process maps for the three different types of visits. Process maps for the three types of visits were created through a mix of stakeholder interviews and observational data. Non-resource intensive steps (colored white), such as patient waiting time and e-paperwork, do not incur clinic costs and were excluded from future calculations of cost using time-driven activity-based costing (TDABC). MA, medical assistant; PA, physician assistant.

Figure 2

Visit costs by visit type and resource type. Visit costs compared between traditional clinic visits and physician-led video visits show minimal difference. However, physician assistant-led video visits were on average $17.40 cheaper than physician-led video visits. Data was obtained through in-person observation of each visit and calculated using time-driven activity-based costing.