Introduction

The current healthcare climate demands high-quality efficient care delivered at a low cost. This study compares costs associated with tele-urology versus conventional face-to-face clinic visits for the initial outpatient evaluation of patients with hematuria.

Methods

We evaluated costs associated with hematuria evaluations among patients evaluated either through a tele-urology encounter by phone or in-person face-to-face clinic visit. This analysis included three main domains of costs: transportation, clinic operations (administrative, nursing and provider-related), and patient time. Transportation cost was based on data from the Veteran Transportation Services (travel distance, time, and reimbursement schedules), standard federal transportation reimbursement costs ($0.541/mile). When needed, wheelchair-dependent special mode transportation costs $130 plus $4.25/mile. Clinic operation staff cost (inclusive of 25% fringe benefits) was calculated based on hourly salary of nursing and clerical staff ($34.87 and $29.88, respectively). The total time spent by the patient for a face-to-face clinic included time for travel, parking, walking (to and from clinic), check-in and check-out, nurse's evaluation, urological evaluation by provider, laboratory time and waiting time (waiting for check-in, check-out, tests, nurse evaluation and provider evaluation). Cost of patient time was based on the Federal minimum wage of $7.25/hour. Provider time (40min) and Lab time (30min) were excluded from the comparative cost analysis since these tasks were deemed similar for both encounters.

Results

A total of 400 initial hematuria evaluations was studied; 300 tele-urology and 100 standard face-to-face clinic visits (controls). The distributions of micro- and gross hematuria were similar in both groups (~70:30, p=0.67). Both groups had a similar median age (63 vs 62 years, p=0.48) and similar median travel distance and time (58 vs 54 miles, p=0.19; 94 vs 82 minutes, p=0.09, respectively). The average time expended by the patient was significantly greater for face-to-face encounter compared to tele-urology (266 vs. 70 minutes, p<0.001). Exclusive of provider cost, transportation was the primary driver of cost ($83.47/encounter), followed by patient time ($32.87/encounter) and non-provider clinic staff cost ($18.68/encounter). Exclusive of provider cost, the average cost per encounter was $135.02 for face-to-face clinic and $10.95 for tele-urology (p>0.001). The cost saving associated with each tele-hematuria encounter totaled $124.07, with VA saving of $75.04 (60.5%) and patient saving of $49.03 (39.5%).

Conclusions

Tele-urology offers cost savings of ~$124 per encounter for the initial evaluation of hematuria compared to conventional face-to-face clinic. With 1.5 million hematuria encounters in the US annually, a nationwide implementation of tele-urology for hematuria evaluation would offer an annual cost saving in excess of $180 million.

Funding

_x000D_ none