The Effect of Pre‐Appointment Consultation Triage on Patient Selection and Revenue Generation in a University Rheumatology Practice

Abstract

Pre-appointment consult screening is an effective method to identify patients with an AIRD. This enables timely access to care for patients with the highest need of evaluation and results in significantly more revenue generation. This article is protected by copyright. All rights reserved.

Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

“…Smole, et al (4) , made use of service models which employed in-person screening, and reduced the waiting time for the rst appointment with the rheumatologist from months to weeks, or even days. Moreover, with regard to in-person screening, West et al (2) conducted an analysis with almost a thousand patients in which only 4 patients remained without a diagnosis of their immune-mediated rheumatic diseases. Owing to the new dynamic features of the screening model (which also effectively allowed a new assessment to be made much earlier), they were able to review the signs of disease and symptoms of the patients and thus provide the due continuity required for the treatment (1,2,3,4) .…”

Reply

“…He expresses 2 concerns in regard to our recommendation to screen outpatient rheumatology consults to prioritize evaluating patients with inflammatory rheumatic diseases over patients with noninflammatory musculoskeletal disorders. This screening process, which has been used at the University of Colorado, was found to generate 44 times more revenue (1). We suggested this screening process could be used to support higher compensation for clinical academic rheumatologists, who have been shown in 2 studies to generate 10 to 12 times more downstream revenue than they are paid (2,3).…”

Clinical Academic Rheumatology: Still Getting More Than You Pay For

“…Screening of all outpatient rheumatology consults and scheduling of only patients with an inflammatory rheumatic disease in the university outpatient rheumatology clinic, assuring that patients most in need of rheumatologic care are seen in a timely manner and that more complicated cases are available for training fellows and residents. The university hospital administration recognizes the advantage of scheduling these patients who generate higher E&M codes and significantly more (44 times as much) downstream revenue for the hospital compared to patients with noninflammatory musculoskeletal problems (5).…”

“…Scholarly excellence can be demonstrated through multiple means (including publications, curriculum development, leadership on education committees), as well as other methods. Incorporation of a non‐proceduralist agreement that stipulates that the university hospital will supplement clinical income to the rheumatology division on a sliding scale based on prespecified work relative value units generated utilizing 8 half days per week of outpatient clinical time as 1.0 full‐time equivalent workload. Receipt of credit for clinician‐educators for academic production (such as lectures and published articles) and a monetary bonus as a reward that can only be used for nonsalary purposes, including costs of medical licenses and educational expenses (such as meeting costs and travel reimbursement). Functioning of the hospital infusion center as a pharmacy benefit manager; the hospital administration is aware and regularly reminded of the income generated by infusion of biologics ordered by clinical rheumatologists, which lessens the pressure to continually see more patients. Screening of all outpatient rheumatology consults and scheduling of only patients with an inflammatory rheumatic disease in the university outpatient rheumatology clinic, assuring that patients most in need of rheumatologic care are seen in a timely manner and that more complicated cases are available for training fellows and residents. The university hospital administration recognizes the advantage of scheduling these patients who generate higher E&M codes and significantly more (44 times as much) downstream revenue for the hospital compared to patients with noninflammatory musculoskeletal problems (5). …”