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Anh-Danh T Phan, Allison Pernic, Eric D Doerr, Jacob J Koczman, Chi-Wah Rudy Yung, Mark M Kaehr; Cost analysis of telemedicine diabetic retinopathy screening in a county hospital population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5332. doi: https://doi.org/.
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To determine, from the health insurer’s perspective, the cost of screening patients with diabetes mellitus through telemedicine within a county hospital setting and to calculate the cost-effectiveness of this intervention as compared with that of other medical screening interventions.
IRB-approved case series study, incorporating actual health insurance demographics. Patients were noncompliant with recommended yearly diabetic eye examination. Camera retinal imaging in the primary care clinic was obtained in place of traditional eye clinic examination. Patients having diabetic retinopathy (DR) or unreadable image(s) were further referred for eye clinic examination. Main outcome measures were: percentage of DR and unreadable images, health insurance- and physician work Relative Value Units (RVU)-rated cost of screening.
Patient encounters totaled 1,793 at four primary care clinics between June 2009 and February 2013. DR was found in 15% of patient encounters. Medi-care- and Medi-caid-covered cost of screening was 16% less expensive when performed instead in the primary care setting. County health insurance accounted for the majority (43%) of patient encounters and was 32% less expensive. Physician work RVU analysis revealed nearly 700 eye clinic visits were avoided. Image(s) were unreadable in 20% of patient encounters.
Our analysis indicates that telemedicine screening aimed at improving eye care for diabetic persons in the county hospital setting with its unique payer demographics results in substantial county, state, and federal budgetary savings. Telemedicine screening for DR is more cost-effective than many routinely provided health interventions. Because diabetic eye disease is the leading cause of blindness among adult Americans, these results support widespread use of telemedicine as part of the medical care of diabetic persons in the county hospital setting. Additional savings can come by addressing image unreadability.
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