Determining the Marginal Cost Differences of a Telehealth Versus an In-person Occupational Therapy Evaluation Session for Stroke Survivors Using Time-driven Activity-based Costing

Abstract

ObjectiveTo estimate the marginal cost differences and care delivery process of a telerehabilitation vs outpatient session. DesignThis study used a time-driven activity-based costing approach including (1) observation of rehabilitation sessions and creation of manual time stamps, (2) structured and recorded interviews with 2 occupational therapists familiar with outpatient therapy and 2 therapists familiar with telerehabilitation, (3) collection of standard wages for providers, and (4) the creation of an iterative flowchart of both an outpatient and telerehabilitation session care delivery process. SettingTelerehabilitation and outpatient therapy evaluation. ParticipantsThree therapists familiar with care deliver for telerehabilitation or outpatient therapy (N=3). InterventionsNot applicable. Main Outcome MeasuresMarginal cost difference between telerehabilitation and outpatient therapy evaluations. ResultsOverall, telerehabilitation ($225.41) was more costly than outpatient therapy ($168.29) per session for a cost difference of $57.12. Primary time drivers of this finding were initial phone calls (0 minutes for OP therapists vs 35 minutes for TR) and post documentation (5 minutes for OP vs 30 minutes for TR) demands for telerehabilitation. ConclusionsTelerehabilitation is an emerging platform with the potential to reduce costs, improve health care inequities, and facilitate better patient outcomes. Improvements in documentation practices, staffing, technology, and reimbursement structuring would allow for a more successful translation.