1. Diagnostic management by gatekeepers is not cost effective for neuro-ophthalmology.
- Author
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Dillon EC, Sergott RC, Savino PJ, and Bosley TM
- Subjects
- Blepharoptosis diagnosis, Blepharoptosis economics, Cost-Benefit Analysis, Diplopia diagnosis, Diplopia economics, Exophthalmos diagnosis, Exophthalmos economics, Eye Diseases diagnosis, Humans, Managed Care Programs, Optic Nerve Diseases diagnosis, Optic Nerve Diseases economics, Referral and Consultation economics, Retrospective Studies, United States, Diagnostic Tests, Routine economics, Eye Diseases economics, Ophthalmology, Primary Health Care
- 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.
- Published
- 1994
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