Follow-Up Visits Using Evidence-Based Guidelines Could Save Billions
By Katie Wike, contributing writer
Study finds scheduling follow-up visits may be habitual; using evidence-based guidelines would save money, provide better access to care
The study “Evidence-Based Guidelines to Determine Follow-up Intervals: A Call for Action,” published on The American Journal of Managed Care, suggests scheduling follow-up visits using evidence-based guidelines could save the healthcare industry billions of dollars.
The study reviewed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and went deeper into past studies to find evidence of sufficiently high healthcare costs that could be eliminated with follow up visits. According to EHR Intelligence, this review found that in 2010 follow-up visits for “mental disorders, back problems, arthritis, chronic obstructive pulmonary disease/asthma, and hypertension” contributed to a total cost of roughly $281 billion.
“Using hypertension, which saw $13.03 billion in outpatient visits costs as part of $47.4 billion in overall spending, as a model, the study authors suggested that moving a follow-up visit from six to seven months from the initial one would decrease yearly visits by 15 percent and save almost $682 million. Extending to range to an annual appointment could save $2.3 billion and could reduce visits up to 50 percent. So long as care is not compromised by extending the time between follow-up visits, healthcare organizations are advised to do so to help reduce costs and increase overall patient access to care.”
This study’s authors summarized their research, writing, “In this era of healthcare reform, managing follow-up visits and intervals is an evidence-based approach that has the potential to reduce costs per person and improve access without compromising or restricting care. In order to implement this plan, appropriate follow-up intervals must first be established based on healthcare outcomes.
“Physicians should tackle this first step by focusing research efforts and funding on the development of evidence-based follow-up guidelines for common chronic diagnoses. The same scientific rigor that guides therapeutic decision making should be used to optimize chronic disease management. Rational choice of follow-up intervals is a crucial step in adjusting current utilization patterns to maximize the quality of patient care while minimizing unnecessary costs. It’s a win for everyone.”
One way providers are managing follow-up visits is through mobile health. Mental health issues are one of the leading reasons for outpatient visits, and Mind The Science Gap reports text messaging can be used as a “mood ring” of sorts for gauging depression in patients. “Participants sign up to receive daily text messages which asks them to rate their mood from 1-10. They can securely respond via text message with an option to include more details about their mood. This information is logged and can be shared with their doctor.
“Preliminary data published in the Journal of Participatory Medicine saw a compliance rate of 87 percent over a 40-day period among a non-clinical population at Johns Hopkins. According to data collected from Mood 24/7 servers, there are about 4,000 users per month that generate over 240,000 mood ratings in a six month period. The small number of users creating a lot of text messages suggests user engagement with this tool. In a clinical setting, one therapist saw 91.4 percent compliance among 35 mental health patients in a rural community.”
Another mobile initiative, according to mHealthNews, is reminding heart transplant patients to take their medications via text messages. “Despite extensive educational programs for families and pediatric heart transplant recipients, significant medication noncompliance still occurs with alarming frequency, particularly with adolescents, which can prove deadly,” said Linda Addonizio, the director of the program for Pediatric Cardiomyopathy Heart Failure and Transplantation at NewYork-Presbyterian/Morgan Stanley Children’s Hospital.
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