ABSTRACT
During the coronavirus pandemic, asynchronous teledermatology and tele-triage have become increasingly essential, but reimbursement is not widespread. Our study of an asynchronous teledermatology eConsult program for “suspicious lesions” aims to calculate potential cost-savings of the program with recent telemedicine reimbursement rates published by the Centers for Medicare & Medicaid Services (CMS), as compared with a traditional ambulatory model, using observed and projected frequencies of skin biopsies at our institution. We conducted a 3-year retrospective cohort study of patient characteristics, clinical outcomes, and payer costs associated with “suspicious lesion” eConsults. For 348 cases receiving eConsult for a single suspicious lesion within our study period, the eConsult program cost $32,298.40 ($92.81/case). Compared with a traditional standalone ambulatory model, tele-triage could potentially save $8252.59 ($23.71/case) based on the 41.8% observed biopsy rate in eConsult patients subsequently presenting to ambulatory clinic. We calculated a minimum savings of $2348.86 ($6.75/case) using a 23.6% theoretical biopsy rate based on suspicious lesion eConsults not recommended in-person evaluation but who nonetheless presented in ambulatory clinic for assessment of the lesion. Threshold analysis using the actual cost of the eConsult program revealed that institutions with biopsy rate greater than 16.4% for new patients presenting with “suspicious lesions” could yield cost-savings from tele-triage compared with a standalone ambulatory model. Overall, health systems may consider exploring tele-triage of new patients with suspicious lesions given its potential for cost savings. Limitations of this study include its single-center, retrospective design as well as utilization of reimbursement codes from one payer type.