Electronic Consultations Could Improve Access to Rheumatologic Care

E-consults can help weed out unnecessary referrals and avoid unnecessary face-to-face visits, saving time and money. The turn-around time for specialist response to a consulting provider at ConferMED is 24 hours, Dr. Anderson says. A recent analysis of ConferMED’s impact on Medicaid patients showed e-consults saving an average of $82 per patient per month for specialty care compared with face-to-face visits.³

Since ConferMED’s inception, rheumatology e-consults have eliminated 78% of unnecessary face-to-face visits. Of the 3,165 total rheumatology e-consults conducted, 1,193 occurred in the past year alone. Further, ConferMED is currently active in only 21 states but is expanding. “Our data show that an enormous number of rheumatology referrals probably don’t need a face-to-face visit. There just isn’t much rheumatology training in primary care. So a minimally positive anti-nuclear antibody (ANA) test results in a rheumatology referral no matter what,” Dr. Anderson says. In e-consults, specialists can include written explanations of recommendations, frequently supported by references from the literature. That means “we also get to capitalize on a teaching opportunity for the consulting provider, perhaps preventing another unneeded referral down the line,” he adds.

Benefits in Specialty Care

Although e-consults are relatively new, they are already showing measurable benefit in our field. A 2018 study showed that implementation of an e-consult service in Canada improved rheumatology care access, with a median response time by a rheumatologist to the consulting provider of just under two days. A face-to-face referral was avoided in 38% of cases.⁴ At a large healthcare center in Texas, e-consults for positive ANA test referrals were associated with decreased wait times for in-person visits, without a significant increase in resource utilization. Seventy-six percent of these referrals did not require an in-person visit after initial e-consult, and 73% ultimately did not have a rheumatologic diagnosis.⁵

Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She received her training in internal medicine and rheumatology at Johns Hopkins University, Baltimore. She is also a member of the ACR Insurance Subcommittee.

References

1. Andersen L. How to handle the waiting period to see a rheumatologist if you think you have rheumatoid arthritis. CreakyJoints. 2021 Jul 20.
2. Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology workforce study: Supply and demand projections of adult rheumatology workforce, 2015–2030. Arthritis Care Res (Hoboken). 2018;70(4):617–626.
3. Anderson D, Villagra VG, Coman E, et al. Reduced cost of specialty care using electronic consultations for Medicaid patients. Health Aff (Millwood). 2018 Dec;37(12):2031–2036.
4. Rostom K, Smith CD, Liddy C, et al. Improving access to rheumatologists: Use and benefits of an electronic consultation service. J Rheumatol. 2018 Jan;45(1):137–140.
5. Patel V, Stewart D, Horstman MJ. E-consults: An effective way to decrease clinic wait times in rheumatology. BMC Rheumatol. 2020 Oct 15;4:54.