Abstracts

Rationale: As part of the Affordable Care Act, the quality of care is being judged not just on the merits of effectiveness, but also on the basis of cost: benefit ratio. This study is a retrospective analysis of the cost effectiveness of the care provided by Children's Hospital of Orange County (CHOC) multidisciplinary epilepsy care team. Prior to 2013, pediatric epileptologists provided the epilepsy care to our patients. With grant funding, we now have an ancillary health care team to assist the epileptologists, including nurse practitioners; nurses; pharmacists; dieticians; social workers; neuropsychologists; child psychiatrists. This care team assists our patients with finances/insurance; education; mental health; and medication compliance. Methods: We analyzed our ""top 20"" utilizers of the health care system before and after the initiation of the CHOC multidisciplinary epilepsy care team. We looked at the number of patient encounters; total care costs; emergency room visits; unscheduled hospitalizations; as well as antiepileptic medications—before and after the initiation of the CHOC multidisciplinary epilepsy care team. We also analyzed the cost effectiveness of our care pre- and post-epilepsy surgery. We have performed 30 epilepsy surgeries since 2012. We have a 95% seizure free outcome for these patients, with the caveat that many of these patients have only been followed for 6-12 months post epilepsy surgery. We looked at the same parameters of care, as outlined in the preceding paragraph. Results: In the ""top 20"" utilizer group, approximately 75% were in the process of being evaluated for epilepsy surgery or were not epilepsy surgery candidates . 25% did have epilepsy surgery between 2012-2014. The cost savings for one physician's ""top 20"" utilizers after the initiation of the CHOC multidisciplinary epilepsy care team was over $153,000. The number of patient encounters dropped over 50%. Our intractable epilepsy patient population increased 65% from 2445 patients to 4038 patients. Despite the increase in regional and national referrals, as well as heightened patient complexity, the cost per patient encounter did not significantly change. With respect to our patients who did have epilepsy surgery, the results are more striking. We have performed 30 epilepsy surgeries in the past three years. Our patients have a 95% seizure free outcome. Post-surgery, these patients have had a dramatic decrease in patient encounters and costs. Many of our patients had multiple hospitalizations for status epilepticus and/or seizure exacerbation prior to epilepsy surgery. The number of unscheduled hospitalizations and emergency room visits has been virtually eliminated since surgery. The number of patient encounters has been reduced by over 75%, with the majority of our patients being seen once every six months. The cost of care has also been decreased by 75-95%. Conclusions: With the advent of the Affordable Care Act, multidisciplinary epilepsy care teams similar to the one designed at CHOC provide cost-effective care and should be used as a template for other epilepsy centers.