P-2103. Implementation of an Infectious Disease eConsult Service at an Urban Academic Medical Center

TL;DR

An infectious disease eConsult service was implemented at an urban hospital, showing high satisfaction and revenue potential, especially for immunocompromised patients.

Contribution

The study introduces a novel financial analysis of eConsults and highlights their use for immunocompromised patients, including transplant cases.

Findings

72% of eConsults involved immunocompromised patients, with 24% related to transplant donors or recipients.

92% of eConsults were billable, generating an average hourly reimbursement rate of $190.66.

89% of referring providers rated the service as excellent and would recommend it.

Abstract

Access to infectious disease (ID) consultation is severely limited with ID specialists present in only 20% of United States counties (Walensky et al, PMID: 32491920). Electronic provider-to-provider consultations (eConsults) offer one option for increasing access, previously demonstrating effective delivery of ID services well-received by referring providers (Hofmann et al, PMID: 38813258; Murthy et al, PMID: 28470015).Figure 1Infectious Disease eConsults by SpecialtyFigure 2Infectious Disease eConsults by Question Type

Infectious Disease eConsults by Specialty

Infectious Disease eConsults by Question Type

At a large urban academic medical center, an ID eConsult service was offered to providers of all specialties. We analyzed electronic health record data regarding eConsults for quality improvement purposes and distributed a provider satisfaction survey to referring providers.Figure 3Infectious Disease eConsults by Transplant StatusTable 1Infectious Disease eConsults by Question Topic

Infectious Disease eConsults by Transplant Status

Infectious Disease eConsults by Question Topic

Among 515 ID eConsults over 10 months, 44% were placed by primary care providers, 30% by medical sub-specialists, and 20% by surgeons. Questions on immunocompromised patients comprised 72% of consults, including 24% on solid organ transplant donors or recipients. The most common consult questions concerned therapeutic management (43%), diagnostic management (14%), and interpretation of either culture (13%) or serology (19%) results. The most common topics included urinary tract infection (17%), gastrointestinal infections (9%), tuberculosis (7%), and tick-borne illnesses (6%).

Analysis of reimbursement data showed that 92% of eConsults were billable, covered by 20 of 23 local insurance plans with average reimbursement of $48.82 and average amount of time spent of 7 minutes per eConsult, resulting in a calculated hourly reimbursement rate of $190.66/hr. Most of the 53 survey respondents rated the quality of the service as excellent (89%), were extremely satisfied with the response they received (87%), or would recommend the service to others (89%).

This study is unique in the eConsult literature due to its high proportion of immunocompromised patients including transplant donors and recipients. It also includes a novel financial analysis demonstrating that most eConsults were billable and revenue-generating for the ID division, with a high level of satisfaction by referring providers. Future areas of inquiry include the impact of ID eConsult programs on access to care, consultant/patient satisfaction and antibiotic stewardship.

All Authors: No reported disclosures

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