Study: Teledermatology for triage, treatment produced significant cost savings over conventional care

The use of teledermatology (TD) to triage dermatology patients within a capitated health system can result in significant cost savings, according to researchers.

The researchers found that implementation of the teledermatology triage system at Zuckerberg San Francisco General Hospital saved $140 per newly referred dermatology patient, compared with a conventional dermatology care model.

“Therefore, TD has the potential to produce cost savings when applied in closed health care systems,” wrote study authors Adam Zakaria, BA, Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, and colleagues in JAMA Dermatology.

Zakaria and colleagues pointed out that studies have shown that teledermatology can improve both patient access to care and clinical efficiency without sacrificing patient experience. Yet the results of these studies have been inconsistent regarding the fiscal impact of teledermatology.

Therefore, in this study, the authors conducted a retrospective cost minimization analysis of the teledermatology system at Zuckerberg San Francisco General Hospital and Trauma Center, which provides subspecialty care services to about 150,000 patients annually, primarily through managed care payment agreements. Its teledermatology program was implemented in 2015. This program requires referring physicians to upload patient photos and history to a web-based teleradiology platform for all non-emergency patient referrals.

An attending dermatologist and dermatology residents convene weekly to determine which patients should have in-person appointments at the hospital (who are then contacted through that web-based platform in order to schedule an appointment). When an in-person visit is not recommended, their work-up and treatment plan is coordinated by the referring physician based on the dermatologist’s recommendation.

The study included 2,098 patients referred to the dermatology department at the Zuckerberg San Francisco General Hospital from June 1 through December 31, 2017. Of those patients, 676 patients (32.2%) spoke a primary language other than English, 879 patients (41.9%) identified as non-White, and 1,099 patients had Medi-Cal.

The top 3 diagnostic categories within the study cohort were benign growth (32.0%), infection (14.5%), and eczematous dermatitis (12.4%), followed by neoplasm of uncertain significance (6.5%), psoriasis (5.6%), and acne or rosacea (5.2%).

Based on decision-tree cost modeling using actual costs, Zakaria and colleagues found that the mean cost per patient with the teledermatology triage model was $559.84, while the estimated mean (SD) cost per patient within the conventional care model was $699.96. Thus, the mean per-patient cost savings associated with teledermatology implementation was $140.12 — a statistically significant difference. When extrapolated to reflect an annual dermatology referral volume of 3,150 patients, the authors estimated the teledermatology program saves $441,378 annually.

Additionally, sensitivity analysis demonstrated that teledermatology consultations would have to be more than 4 times more expensive for the dermatology triage and conventional cafe models to be cost neutral.

Zakaria and colleagues suggested that their analysis may even underestimate the cost savings associated with teledermatology. For example, they found that teledermatology produced cost savings even though their analysis included implementation costs, suggesting that the cost savings of Zuckerberg San Francisco General Hospital’s program should be lowest at the outset of the program, and steadily increase.

In an editorial accompanying the study, April W. Armstrong, MD, MPH and Indira Singh, MD, both of the Keck School of Medicine, University of Southern California, Los Angeles, California, noted that while the practice of teledermatology is likely to increase in the future, the economics associated with it will vary depending on perspective.

For example, while Zakaria and colleagues may have demonstrated the potential cost savings of teledermatology from the perspective of a safety-net capitated model, Armstrong and Singh suggested that the economics for individual dermatologists working in a fee-for-service setting will vary and may depend on CMS and private payer reimbursement policies, the time needed to obtain complete and accurate images and address technical difficulties, and their inability to perform procedures.

“In certain settings, even if teledermatology may be associated with increased costs, those costs may be justified by the benefit of timely diagnosis, management, and improved patient outcomes,” wrote Armstrong and Singh. “Overall, as the adoption of teledermatology increases, it is important to ensure high-quality care for patients and fair compensation for the dermatology workforce practicing teledermatology.”

  1. The introduction of a dermatology triage system has resulted in signficant cost savings in a managed care setting.

  2. A San Francisco hospital saved $140 per newly referred patient with the dermatology triage model compared to a conventional model over the course of the study.

Michael Bassett, Contributing Writer, BreakingMED™

Armstrong reported grants and personal fees from AbbVie, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, LEO Pharma, Novartis, Regeneron, Pfizer, and UCB Biopharma; grants from Galderma and Kyowa Hakko Kirin; and personal fees from Celgene, Genentech, Boehringer Ingelheim, Modernizing Medicine, Ortho Dermatologics, Sun Pharma, Sanofi Genzyme, Valeant, Beiersdorf, and Janssen outside the submitted work.

Cat ID: 105

Topic ID: 75,105,509,556,105,192,919,923,925