Diagnostic management by gatekeepers is not cost effective for neuro-ophthalmology.
Publication/Presentation Date
9-1-1994
Abstract
PURPOSE: To determine whether the "gatekeeper physician system" for evaluating neuro-ophthalmologic problems is cost effective.
METHODS: The authors retrospectively reviewed the records of 588 patients referred for neuro-ophthalmologic evaluation between July and December 1989 to determine the frequency and cost of unnecessary diagnostic testing ordered by "gatekeeper physicians." Pre-referral diagnostic testing costs were compared with the cost of neurophthalmologic consultation for four common problems: (1) optic neuropathy; (2) diplopia; (3) ptosis; and (4) proptosis.
RESULTS: Between 16% and 26% of patients in the first three diagnostic categories were subjected to overtesting, resulting in $57,900 of excessive costs, a 724% overcharge. Although the evaluation of proptosis was performed correctly, the quality of 10 of the 18 neuro-imaging procedures was substandard.
CONCLUSIONS: The gatekeeper system managed by primary care physicians for these four neuro-ophthalmologic problems not only did not conserve healthcare dollars but also had a negative impact on cost control. For neuro-ophthalmologic disorders, prompt subspecialty evaluation and examination appear to be a cost-effective strategy.
Volume
101
Issue
9
First Page
1627
Last Page
1630
ISSN
0161-6420
Published In/Presented At
Dillon, E. C., Sergott, R. C., Savino, P. J., & Bosley, T. M. (1994). Diagnostic management by gatekeepers is not cost effective for neuro-ophthalmology. Ophthalmology, 101(9), 1627–1630. https://doi.org/10.1016/s0161-6420(94)31127-4
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
8090467
Department(s)
Administration and Leadership
Document Type
Article