Discussions regarding “cost” and “value” seem to dominate every conversation about healthcare these days. In a recent editorial in the Journal of the Pediatric Infectious Diseases Society, PIDS immediate past-president Dr. Gilsdorf and colleagues commented that pediatric infectious disease physicians’ “compensation, which is determined by leaders of pediatric departments and hospitals, does not take into account our overall value to the hospital in clinical and nonclinical work as well as in potential cost-saving activities.” This is an appropriate lead-in to an article published in the June 2018 issue of JPIDS by researchers from Doernbecher Children’s Hospital in Portland, Oregon entitled “Utilizing a Modified Care Coordination Measurement Tool to Capture Value for a Pediatric Outpatient Parenteral and Prolonged Oral Antibiotic Therapy Program.” This article sought to determine the amount of time spent by pediatric infectious disease providers on non-reimbursable care coordination activities in the context of a pediatric outpatient antimicrobial therapy program (OPAT).

In this study, care coordination as related to OPAT was assessed using the “Care Coordination Measurement Tool,” which was previously developed to evaluate the activities that occur within care coordination (CC), the resources needed, and the outcomes impacted. All encounters related to OPAT that included non-reimbursable tasks were recorded over a six-week period, and data regarding the time spent and types of activities performed were collected. Additionally, the OPAT providers prospectively recorded whether an outcome (such as an ER visit) was prevented.

In total, 154 CC encounters were recorded on 29 patients during the time period in question. The most common activity performed during these encounters was “clinical/medical management” (31%) followed by lab management (17%), family/patient advice (15%), and coordination among subspecialty providers (10%). Over the study period, CC activities totaled an estimated 54 hours of non-reimbursable work. Eight patients who lived a long distance from the clinic were managed completely through CC encounters and coordination with local primary care providers and did not have any billable pediatric ID clinic visits. Ten ER visits and two hospital admissions were prevented through CC encounters. The authors concluded that non-reimbursable CC through an OPAT program leads to improved outcomes for both patients and healthcare systems, as well as substantial cost savings (estimated $29,000 of costs avoided in this short six-week period).

This study provides a real-life example of how pediatric infectious disease programs can quantify the value that they add to a healthcare system or hospital outside of “billable clinical activities.” These additional activities may include coordination of OPAT, antimicrobial stewardship, and infection prevention. Similar to this study, providers engaged in these activities can consider prospective recording of time spent and activities performed over a short time period. An estimation of potential negative outcomes avoided, and cost savings could subsequently be presented to hospital and department administration, in order to justify obtaining financial support for providers to carry out these activities. In an era when cost and value are being constantly scrutinized, it is paramount that pediatric infectious disease physicians have a means to demonstrate their value to the system. Studies such as this one provide a framework for such conversations. The value of ID services may be clear to us all, but our ability to demonstrate this to the health systems in which we work will be critical to the future survival and growth of the specialty of pediatric infectious diseases.

-Natasha Nakra, MD