Time spent with patients and charges to patients for specialty consultations using telemedicine

The objective of this work was to determine some of the determinants of cost in teleconsultations as compared to face-to-face consultations. Time spent with patients and estimated costs were modeled using time series data from a university Health Science Center located in West Texas. This center provides education, patient care, community service and research to a 109 county area. Data, collected from 184 consecutive telemedical consultations, included patient, primary care provider and specialist characteristics; time spent with patients; and estimated charges. More time was spent with patients if: payment was through private insurance, more specialists were involved in the consult, or the specialist had practiced medicine longer. Consultations took less time if the specialist was a neonatologist, and less time if the specialist recently completed medical training. Estimated charges to patients were higher if: the consult was longer in duration, multiple specialists were involved, the patient was female, the consultation involved endocrinology or dermatology, or the patient came from a rural community. Charges were lower for consults involving a neonatologist. Estimated charges were determined primarily by time spent with the patient and the kind of specialist involved, with time being the more important of the two factors. Telemedicine consultations required less time for patients with private insurance or those seeing a neonatologist. Broad or complex cases requiring multiple specialists required more interaction time. The more time and more specialists involved, the more potentially costly the teleconsultation.