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   Costs, Quality and Access to Care

AFHCAN continues to study the effects of telemedicine on travel – and potential cost savings. In a recent study of telehealth cases that were reimbursed through Medicaid, an average of $4.41 was saved by Medicaid in travel costs for every $1 spent on claims. Preliminary data indicates that 37% of the time, telemedicine cases prevent the patient and family from having to travel. Extrapolated to 13,307 encounters, this results in over $2.8 million saved in airfares alone. AFHCAN has supported a contract audiologist that travels to remote sites in Alaska to provide audiological services. This allows the provider to provide “point of care” specialty service at the village level and, leveraging the common statewide telehealth platform, to send cases for immediate referral to ENT specialists in Anchorage. To date, this has been supported at 12 remote sites and included 263 patients at a an average cost of $68 per patient. Approximately 42% of the patients had outcomes that mitigated a need to travel to see a specialist. Others were started on medications (23%) that may not otherwise have happened for months, and 47% were referred directly to surgery, further testing, a regional clinic, or to another specialist. This study indicates that we can use the telehealth technology to support a “non-specialist” to travel to remote sites and effectively “triage” patients for faster access to care. In this case, the audiologist was able to create and send cases to the ANMC ENT specialists, and obviated the need for about 42% of the patients to attend specialty clinic. This has the potential for significant costs savings (exact $ amount yet to be calculated). Alaska Native Medical Center is currently working on a business plan, with the possibility that a “traveling audiologist” will be a routine business venture for ANMC. The ENT department within ANMC actively use AFHCAN systems to obtain patient information prior to surgical referrals. It appears that this additional information provides greater accuracy in predicting the procedure and time required in the operating room. Recognizing that the operating room is a significant bottleneck in hospital operations, this suggests that telemedicine may be used to greatly enhance the efficiency of hospital operations. This study is currently underway.

The ENT department at ANMC manages to see about 1,200 telemedicine cases each year – without additional staff. Images, such as this cholesteatoma at the left, can be diagnosed through telemedicine images. 1200 cases represents the equivalent workload of adding ½ FTE staff physician to the department. To provide the same service – in terms of sending this ½ FTE out to the regional hospitals for specialty clinic – would cost about $63,000 in salary annually, plus the cost for travel, lodging and perdiem. Access to care has accelerated dramatically for regional hospitals. Some specialty clinics at regional hospitals had waiting times of 9 to 15 months prior to telemedicine, but now have virtually no waiting time for patients to get appointments. Telemedicine has allowed these clinics to effectively triage their patients, so that patients are seen faster and referred more directly to Anchorage for services. The success story in the Yukon-Kuskokwim region is dramatic. Patients have been diagnosed, had surgery and returned back home receiving a telemedicine post operative wound check in less time than it used to take to get an ENT appointment.