Abstract
Electronic consultation (eConsult) is an innovative solution that allows specialists and primary care providers to communicate electronically, improving access to specialist care. Understanding the cost implications of different remuneration models available to pay specialists is of critical importance as adoption of these services continues to increase. We used data collected through the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service to simulate the cost implications of different remuneration models in Canada. The prorated hourly rate model averaged $45.72 CAD (Canadian Dollar) per eConsult while the prorated hourly rate with incentive averaged $51.90 CAD per eConsult, and the fee for service cost $60.50 CAD per eConsult. Paying all specialty groups to block three hours per week for eConsults averaged $337.44 CAD per eConsult and paying for 1-h blocks averaged $133.41 CAD per eConsult. As the remuneration of specialists is the largest cost driver of an established eConsult service, our findings can inform policymakers considering the implementation of eConsult or wishing to further develop an existing service.
Highlights
Prompt access to specialist care is a major challenge facing the health care system
This is simulation study of all cases submitted over a one-year period by primary care providers (PCPs) registered to use the Champlain BASE eConsult service
Access to a specialist requires a referral from a PCP or other physician, only the specialist is remunerated for the referral
Summary
Prompt access to specialist care is a major challenge facing the health care system. According to a report from the Fraser Institute, wait times for specialist care in Canada grew 132% between 1997 and 2013 [1]. In an effort to increase access to specialist care and decrease wait times, several countries have implemented electronic consultation (eConsult) services [3,4,5]. These services enable primary care providers (PCPs) and specialists to communicate electronically over a secure web platform in order to discuss a specific patient’s care. EConsult services have been shown to decrease wait times [7], improve care coordination and collegiality between primary and specialty care [8], avoid unnecessary face-to-face specialist visits [9], and provide educational opportunities for both PCPs and specialists [10]. EConsult systems have shown great potential to reduce costs and lead to greater overall health system efficiency [5,11]
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