Background/Purpose: Academic hospital leadership puts a priority on all patients (pts) having access to subspecialists. Often the demand for rheumatology consultation exceeds the ability to see pts promptly. This necessitates a consult triage system to ensure timely appointments for pts with inflammatory rheumatic diseases (IRD). The aim of this study was to evaluate the effectiveness of pre-appointment consult screening to identify pts with potential IRD who need timely access and the revenue implications of caring for these IRD pts compared to non-IRD pts.

Methods: During a 9 month period, all pts referred by a healthcare provider to our University rheumatology practice were screened and classified as either possible IRD or non-IRD based on a pre-appointment records request and review by a rheumatologist. Pts with possible IRD were scheduled for an appointment and diagnosis after clinical evaluation was recorded. Using the 2015 Medicare fee schedule, revenue generated through the care of pts accepted for evaluation was recorded for the subsequent 12 months after initial consultation (Table 1). Outpatient services necessary for initial diagnosis and subsequent patient monitoring were analyzed. Costs of medications, surgical procedures, and hospitalizations were not included. Revenues between IRD and non-IRD pts were compared using a Student’s t-test. Pts categorized as non-IRD based on pre-appointment screening and denied evaluation received subsequent care through their referring provider and clinical outcome at one year was recorded if available.

Results:   Of the 961 referrals, 673 pts (70%) were classified after consult review as possible IRD pts and scheduled for evaluation. Of the 597 pts who presented for initial evaluation (average time to first appointment 13 days, range 1-31), 357 pts (60%) were found to have an IRD (139 RA, 83 SLE/SSc/UCTD/ Sjogren’s, 44 crystal dz, 38 spondylo, 34 vasculitis/myositis, 19 other) and 240 pts (40%) had a non-IRD. Of the 288 pts who were denied evaluation, 128 had follow-up data for at least one year with only six (0.5%) developing an IRD. The sensitivity of consult screening to identify IRD was 98% with a positive predictive value of 60%. Complete revenue data was available for 510 pts (318 pts with IRD, 192 pts with non-IRD); analysis demonstrated that care of pts with IRD generated 5.6 times more revenue compared to non-IRD pts (p<0.05).

Conclusion: Pre-appointment consult screening is an effective method to identify pts with IRD. This allows for timely access to care for pts in highest need of evaluation and for significantly more revenue generation.

Table 1: Total revenue (dollars) generated by patients with IRD versus non-IRD over 12 months

Disclosure: S.West, None; D.Pearson, None; C.Striebich, None; R.Goecker, None; J.Kolfenbach, None