Gino Inverso1, Hannah R Desrochers2, Bonnie L Padwa3. 1. Research Fellow, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; DMD Candidate, Harvard School of Dental Medicine, Boston, MA. 2. Registered Nurse, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. 3. Oral Surgeon-in-Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Associate Professor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA. Electronic address: Bonnie.Padwa@childrens.harvard.edu.
Abstract
PURPOSE: The clinical follow-up visit after third molar extraction has been cited as time consuming and of little benefit to patients. Although telephone follow-up has the potential to add value to the surgical management of third molars, sparse information exists on the financial context of this alternative. The purpose of this study was to show the change in value of third molar extraction with telephone follow-up through 1) measurement of the postoperative complication rate and 2) costs of telephone versus clinical follow-up. MATERIALS AND METHODS: Bivariate comparisons were computed to assess for differences in follow-up type. Cost was calculated from a provider's perspective using micro-costing analysis that quantified cost differences between postoperative telephone and clinical follow-ups. Each visit type was divided into clinical activities and clinicians involved. Cost rates (dollars per minute) were derived for each clinician. Each clinical activity time was multiplied by clinician cost rate to derive an activity-based cost for each activity. Individual activity-based costs were summed to derive the total cost of telephone versus clinical follow-up visit. RESULTS: Patients who had a telephone follow-up had a similar postoperative complication rate (2.1%) as those who had a clinical follow-up (1.9%; P = .94). The total cost estimates were $14.26 for telephone follow-up and $63.33 for clinical follow-up. Overall, there was a cost savings of $49.07 per patient, or a 77.4% decrease in cost, when using telephone follow-up. CONCLUSION: Telephone follow-ups added value to the operative management of patients having third molar extractions by controlling for postoperative complication rate and decreasing cost of care.
PURPOSE: The clinical follow-up visit after third molar extraction has been cited as time consuming and of little benefit to patients. Although telephone follow-up has the potential to add value to the surgical management of third molars, sparse information exists on the financial context of this alternative. The purpose of this study was to show the change in value of third molar extraction with telephone follow-up through 1) measurement of the postoperative complication rate and 2) costs of telephone versus clinical follow-up. MATERIALS AND METHODS: Bivariate comparisons were computed to assess for differences in follow-up type. Cost was calculated from a provider's perspective using micro-costing analysis that quantified cost differences between postoperative telephone and clinical follow-ups. Each visit type was divided into clinical activities and clinicians involved. Cost rates (dollars per minute) were derived for each clinician. Each clinical activity time was multiplied by clinician cost rate to derive an activity-based cost for each activity. Individual activity-based costs were summed to derive the total cost of telephone versus clinical follow-up visit. RESULTS:Patients who had a telephone follow-up had a similar postoperative complication rate (2.1%) as those who had a clinical follow-up (1.9%; P = .94). The total cost estimates were $14.26 for telephone follow-up and $63.33 for clinical follow-up. Overall, there was a cost savings of $49.07 per patient, or a 77.4% decrease in cost, when using telephone follow-up. CONCLUSION: Telephone follow-ups added value to the operative management of patients having third molar extractions by controlling for postoperative complication rate and decreasing cost of care.