Journal article
Determining the Prevalence and Costs of Unnecessary Referrals in Adolescent Idiopathic Scoliosis
The Iowa orthopaedic journal, Vol.39(1), pp.57-61
2019
PMCID: PMC6604530
PMID: 31413675
Appears in Diamond Open Access
Abstract
Adolescent idiopathic scoliosis (AIS) has been associated with unnecessary referrals, but the provider and patient costs associated with these referrals remain unknown. The purpose of this study was to determine the prevalence and associated costs of unnecessary referrals for AIS in a university hospital-based orthopaedic clinic. These data are required to estimate the cost-efficacy of scoliosis screening programs.
We accessed the electronic medical records of all patients referred during 2013-2014 with suspected AIS. Spine radiographs were reviewed to determine whether the referral was "unnecessary," defined as a Cobb angle <20 degrees. Patient and provider costs were estimated. Patient costs included transportation expenses and parental lost wages. Provider costs included orthopaedic evaluation, diagnostic imaging, and overhead. Transportation costs were based on actual driving distances and the Internal Revenue Service standard mileage rate. Parental lost wages and the cost of evaluation by an orthopaedic surgeon were calculated with time-driven activity-based costing. Diagnostic imaging costs were calculated with a traditional activity-based costing methodology.
Three hundred thirty-seven patients were included. The prevalence of unnecessary referrals was 39% (n=131). 17% of patients had a Cobb angle <10 degrees and 22% had a Cobb angle between 10-20 degrees. Males were more likely to be referred unnecessarily than females, 49% to 35% (p=0.02) as were non-Caucasians (54% vs. 37%, p=0.04). No difference was noted related to source of insurance (private or public, p=0.18). The average total cost of an unnecessary referral was $782.13 USD, including $231.07 in patient costs and $551.06 in provider costs.
Nearly 40% of all referrals for AIS were deemed unnecessary. The average cost of an unnecessary referral is approximately $780, imposing significant costs on both patients and the healthcare system.
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Details
- Title: Subtitle
- Determining the Prevalence and Costs of Unnecessary Referrals in Adolescent Idiopathic Scoliosis
- Creators
- Thomas Meirick - University of IowaApurva S Shah - Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA USALori A Dolan - University of IowaStuart L Weinstein - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.39(1), pp.57-61
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 31413675
- PMCID
- PMC6604530
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Grant note
- T35 HL007485 / NHLBI NIH HHS
- Language
- English
- Date published
- 2019
- Academic Unit
- Stead Family Department of Pediatrics; Orthopedics and Rehabilitation
- Record Identifier
- 9984304699002771
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