RESUMO
BACKGROUND: Expansion of telehealth is a high-priority strategic initiative for many health systems. Surgical clinics' implementation of video visits has been identified as a way to improve patient and provider experience. However, whether using video visits can reduce the cost of an outpatient visit is unknown. METHODS: Prospective case study using time-driven activity-based costing at two outpatient surgical clinics at an academic institution. We conducted stakeholder interviews and in-person observations to map outpatient clinic flow and measure resource utilization of four key steps: check-in, vitals collection and rooming, clinician encounter, and check-out. Finally, we calculated the resource cost for each step using representative salary information to calculate total visit cost. RESULTS: Video visits did not systematically reduce the amount of time clinicians spent with patients. Mean [standard deviation (SD)] visit costs were as follows: traditional clinic visits, $26.84 ($10.13); physician-led video visits, $27.26 ($9.69); and physician assistant-led video visits, $9.86 ($2.76). There was no significant difference in the total cost associated with physician-led traditional clinic visits and video visits (P=0.89). However, physician assistant-led video visits were significantly lower cost than physician-led video visits (P<0.001). CONCLUSIONS: Using physician-led video visits does not reduce the cost of outpatient surgical visits when compared to traditional clinic visits. However, the use of less expensive clinician resources for video visits (e.g., physician-assistants) may yield cost savings for clinics.
RESUMO
BACKGROUND: Telemedicine utilization, including use of video visits, is growing rapidly. While much enthusiasm surrounds telemedicine, the successful implementation of video visits within health systems requires providers to evaluate patient's experience with the implemented technology and workflow. METHODS: Twenty patients who completed a video visit in the Department of Urology at Michigan Medicine were contacted and asked if they would be willing to share their experience. Patients underwent a semi-structured telephone interview. Using an interview guide, patients were asked questions about the enrollment process, their overall impression of the visit, and feedback to improve the visit. Interview comments were categorized into three primary themes: usability, quality of the visit, and comparison to a traditional in-clinic visit. RESULTS: Most patients who underwent a urological video visit were highly satisfied with their experience. Most patients also reported being able to join the video visit with minimal issues. However, some patients expressed issues downloading the application and interpreting our educational materials. In regard to quality of the visit, most patients were impressed and pleased. While there was no criticism regarding the picture-quality of the video visit, a few patients reported issues with the audio. It was apparent that quality of video was dependent on quality of the patient's internet connection. When comparing the video visit to a traditional in-clinic visit, patients-especially parents with children at home-found the video visit to be more efficient. CONCLUSIONS: Our study found that patients were pleased with their urological video visit experience, and there were details about our workflow that would not have been evident without interviews. These findings suggest that while video visits are suitable alternatives to in-clinic appointments at academic medical centers, it is important for providers to obtain direct feedback from patients to identify workflow and technical issues.
