Abstracts

This is a Late Breaking abstract

Rationale: Non-epileptic seizures (NES) account for 25% of all referrals to tertiary care epilepsy centers, constituting ~400 annual referrals to the University of Colorado (CU) NES Clinic. Despite this prevalence, only 19 institutions in the United States report having some form of multidisciplinary evaluation and treatment for FND.¹ These subspecialized clinics ensure patients are seen by providers expert in FND, as compared to epileptologists whose training focuses on epilepsy. Sans treatment access, patients with FND account for $1.2 billion and increasing annual costs to Emergency Departments and (ED) inpatient care.² To date, all FND-related health economics research focuses on cost-savings by reduction of ED and inpatient utilization. To our knowledge, this is the first economic evaluation discussing access and cost-effectiveness of integrating an outpatient, multidisciplinary NES clinic in neurology.

Methods: Health Data COMPASS all-payer claims data from 1 year pre-referral through August 24th, 2022 was supplemented by chart review of 250 patients referred to the CU NES Clinic. To estimate the level of new patient visit (NPV) access to epileptologist (EPI) evaluations, we simulated that referral to the NES clinic replaced each return patient visits (RPV) of NES with half of a NPV for a patient with epilepsy. Real-time access to EPI was estimated based on average annual NPVs completed by CU Epilepsy Division. Contribution margin (CM) was defined as the difference between NES patient standard of care with and without the NES Clinic based on the above replacement of RPV for NPV. This was informed by the results of a survey to epileptologists asking: If the NES Clinic did not exist, how often would you schedule follow up? (Figure 1). Annual CM value was calculated using the CU Neurology Department’s (CU Neuro) average reimbursement per CPT code. Costs were categorized 3 ways: total CM gained by increased access to NPV EPI evaluation, CU Neuro margin for completed NES visits with EPI/Movement (MVMT), and loss to CU Neuro due to NES patient no show/cancellations to EPI.

Results: Of the 250 patients, 165 were analyzed. 139 of the 165 patients did not return to EPI thus opening 241 NPVs over a 2-year period. The NES Clinic increased access to EPI by 10.3%. The total CM afforded to CU Neuro after analysis of 165 patients was $67,248 over a 2-year period. Total clinical revenue made by completed EPI/MVMT was $26,529. Total clinical revenue lost by billing an NES RPV vs. EPI NPV was ($18,137) with a margin of $7,113. Revenue lost due to NES patient no show/cancellations to EPI/MVMT was ($33,882).

Conclusions: Given the limited treatment options for patients with FND, these results provide an initial financial rationale for Neurology Departments that a dedicated service for NES/FND is financially efficacious via the increased access to EPI. Future work will analyze this in a larger cohort with respect to inpatient revenue._x000D_ _x000D_ References:_x000D_ 1. Beimer NJ, LaFrance WC Jr. Neurol Clin. In press  _x000D_ 2. Stephen CD, et al. JAMA Neurology. 2020. _x000D_
Funding: Not applicable