Virtual Post-Tonsillectomy Visits: A Model for Recovering Opportunity Costs in the Otolaryngology Clinic
Joanna Kam Lamont R Jones Ilaaf Darrat
Henry Ford Health System
Background: In surgical subspecialties including urology, orthopedics and vascular surgery, telemedicine is used to monitor postoperative recovery. We pose that virtual post-operative encounters can b..
Background: In surgical subspecialties including urology, orthopedics and vascular surgery, telemedicine is used to monitor postoperative recovery. We pose that virtual post-operative encounters can be used to monitor patients’ recovery while increasing the revenue generated in otolaryngology clinics. Objectives: (1) To determine the opportunity cost associated with post-operative visits in the otolaryngology clinic. (2) To evaluate the role of telemedicine in recovering opportunity costs in the otolaryngology clinic by using virtual post-operative tonsillectomy and/or adenoidectomy visits. Methods: Prospective cohort study of 125 pediatric patients who underwent tonsillectomy, and/or adenoidectomy from January to December 2017. Each patient was consented for surgery and offered a choice between a postoperative visit in the clinic, or virtual follow-up delivered in the form of an electronic survey through the HIPPA compliant electronic medical record’s patient portal, Epic MyChart. This was accessed by patients via the Epic MyChart smartphone app, or a web based hyperlink. The post-operative follow-up completion rate was calculated for each setting. Charts were reviewed for occurrences of postoperative bleeding and dysphagia. Follow-up occurred within 4-6 weeks of surgery. Results: The virtual follow-up completion rate was 51.1%. The post-operative clinic visit completion rate was 55%. Fourty-five percent of patients failed to present to their post-operative visits, resulting in 59 unfilled appointments. If each of these 59 appointments was filled and private insurance was billed our department’s average gross patient revenue, an additional $28,320 in charges could be generated. If virtual visits were implemented for all tonsillectomies and/or adenoidectomies performed by our department in 2018, an additional $150,720 could have been charged. Importantly, there was no difference in post-operative bleeding rates between the in-office and virtual follow up groups. All patients had returned to a regular diet. In addition, 97% of patients who complete the virtual post-operative encounter report satisfaction with the follow-up process. Conclusions: Post-operative appointments represent a significant opportunity cost in the otolaryngology clinic given the global period. Virtual follow-up encounters can help to recover opportunity costs, by providing an avenue for post-operative management without hindering clinic access to other patients.