Abstract
Purpose :
Diabetic Retinopathy (DR) is one of the most common ocular manifestations of diabetes and a leading cause of blindness. Current guidelines recommend yearly visits with an ophthalmologist, but adherence to these guidelines is low. This retrospective, cross-sectional study attempted to estimate downstream revenue generation from a DR screening program in the Bronx, an underserved population with a high prevalence of diabetes.
Methods :
Between June 2014 and April 2017, the Montefiore Medical Center implemented a telemedicine-based DR screening program for non-compliant diabetics (no eye exam within the prior year). Non-mydriatic fundus cameras were placed in 8 outpatient primary care sites. Patients were triaged for follow-up depending on the evaluation of the photos taken. 2,832 patients were screened and retrospective chart review (via EPIC EMR) was performed. CPT codes for visits, tests, and procedures within a year of the screening were collected. An unknown number of patients followed up with non-Montefiore ophthalmologists and were excluded from analysis. Revenue was estimated by using the respective yearly-rates for the CPT codes, obtained from the Centers for Medicare and Medicaid Service (CMS).
Results :
Out of the 2,832 patients screened, 2,428 (85.7%) patients had their charts reviewed and 893 (36.8%) patients were seen by Montefiore ophthalmologists within a year of screening. The total revenue was estimated to be $279,930.13. The retina related income generation was estimated to be $193,636.00, while the non-retina related income generation was estimated to be $86,294.13. The per-patient revenue was approximately $313.47. If we assume 100% follow-up within a year and a similar patient distribution, the estimated revenue would be $887,751.54.
Conclusions :
Although a diabetic-retinopathy screening program usually requires an initial investment, this pilot study shows that the cost might be covered by enough downstream revenue, making screening financially viable. Such screening programs can help identify asymptomatic disease processes in non-compliant patients and identify patients that require follow-up to prevent and treat sight threatening disease in a timely fashion. A fundus picture can also help the patient understand their disease and help in compliance with follow up.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.