Value (Business Strategy and Financial Management)

ePoster Presentations

EP-149 - Secondary Cost Savings Associated with School Telehealth

Sunday, April 29
4:25 PM - 4:40 PM
Location: Education Zone, Booth 2416, Screen 5

Introduction: the economic impact of telemedicine is not well understood. From a medical perspective, technology can be more expensive than return revenue or observed cost savings, resulting in negative financial returns. The outcome of the telemedicine is linked to financial sustainability through potential reductions in being treated at more expensive hospital settings, but the efficacy of volume reductions associated with telemedicine is also not well understood.

Methods: Different satisfaction surveys were developed for caregivers and nurses, and deployed across the 2015-2016 and 2016-2017 academic school years. Caregivers received surveys on a quarterly basis if their child was seen in the school telehealth visit, and nurses were given surveys twice per school year. Questions topics with financial impacts included sources of alternative care, school absence, travel costs, and work time saved.

Results: In all, 8,765 students were seen through the school telehealth program between October, 2014 and June 30, 2017. Ninety-seven school telehealth sites are currently active, expanding from 26 schools in the 2014-2015 school year to 57 schools in the 2015-2016 school year, and to 97 schools in the 2016-2017 school year. Throughout these visits, 349 caregivers responded, and 161 nurses responded to the surveys.

Thirty-six percent of the nurses surveyed responded that they strongly believed that the child would have visited an ED or Urgent Care Center if they had not been seen through the school telehealth visit. This equates to approximately 3,155 patients being highly likely to utilize these services. With a cost difference of approximately $1,215 between the ED and the school telehealth service, and approximately $106 between Urgent Care and the school telehealth service, this program potentially provides over $2 million in cost savings.

Forty-three percent of nurses responded strongly believed the school telehealth program reduced illness-related absenteeism, with another thirty-eight percent somewhat agreeing. Furthermore, another forty-three percent strongly believed the child would have left school without the school telehealth program.
On the other hand, over three-quarters of caregivers reported that the child would have missed at least a half of a school day without the telemedicine program. Based on responses, the school telehealth program may have averted over 12,000 illness-related absence days from more than 6,000 student contacts. At an average reimbursable rate of $9,559 per student for the State of Texas (in 2015), or a $53.11 per day reimbursement, this equates to over $650,000 saved to school districts in absences averted.

Transportation costs are yet another aspect of cost savings provided to the caregivers. By applying a $0.55 reimbursable rate to the distance brackets, the school telehealth program potentially saves upwards of $100,000 in travel costs. The average midrange cost for caregivers traveling at least 1 mile is almost $10.00.

Conclusion: This analysis was not exact in determining reimbursement, but looked to assess the potential cost savings due to the school telehealth program. This study shows significant cost savings across several different mechanisms including cost of care, travel, school absences averted, and potentially mitigating lost wages.

Learning Objectives:

Brian Robertson

Director, Evaluation & Performance Improvement
Children's Health System of Texas

Dr. Robertson is a Director of Evaluation & Performance Improvement with Virtual Health at Children’s Health System of Texas, Children’s Medical Center Dallas, and an Instructor at UT Southwestern Medical School in the Division of Emergency Medicine. His role is to oversee efforts to evaluate and expand research on the success of virtual health programs across the hospital, examining program efficacy ranging from patient outcomes to financial sustainability. He (has a) Master’s Degree in Public Health, a PhD in Public Affairs, and over 10 years of research and evaluation experience across clinical and non-clinical services.


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Karen E. Kaighan

Director of School Health Programs
Children's Health

Karen Kaighan received her Baccalaureate in Nursing degree from the University of Oklahoma. She started her nursing career at Parkland hospital working on a med-surge unit. After a brief stay, she entered into Community nursing as a School Nurse for Richardson ISD. She provided care for students on 2 elementary campuses before moving onto Frisco ISD as the School Nurse at Frisco High School, her alma mater, and as the Asst. Health Director for the school district. She left the district to complete her Master of Science in Nursing (MSN) and a Master of Public Health (MPH) degrees while taking on the Role of Bioterrorism Coordinator for the Collin County Department of Homeland Security. She was responsible for the planning and coordinating of a county wide response plan for a public health emergency. She left her position to teach at Texas Woman’s University in the College of Nursing. She taught the community health course in the Undergraduate program and online courses for the RN to BSN program. After 7 years in that position, and 3 children later, she began working at Children’s Health in Dallas in the Virtual Health department. Her role includes the coordination and delivering of telehealth in schools across the metroplex. She also provides training for school and community nurses. She has been married for 20 years to her husband Mike and they live in Irving, Texas.


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Stormee Williams

Medical Director School Telemedicine
Children's Health Dallas

Stormee Williams, M.D., is a board-certified pediatrician who has practiced in the Dallas area for over 12 years. She has worked for a Federally Qualified Health Center in south Dallas and has functioned as the Lead Physician in community health clinics for both Parkland Health and Hospital Systems and Children’s Health System in Dallas. Dr. Williams currently serves as the Medical Director for Children’s Health School Telehealth program – one of the largest and fastest growing programs of its type. Through telemedicine, she is able to provide quality healthcare to children who may have limited access to pediatric providers by using technology and peripheral devices. Believing in and supporting the Whole School, Whole Community, Whole Child model, Dr. Williams enjoys working closely with hospital and school administrators to bridge the gap between the healthcare and education sectors and by advocating for the role technology and innovation play in leading to improved access to healthcare.


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Julie C. Hall-Barrow

Vice President, Virtual Health and Innovation
Children's Health System of Texas

Dr. Julie Hall-Barrow is the vice president of virtual health and innovation at Children’s Health, the leading pediatric health system in North Texas. Since joining in 2015, Dr. Hall-Barrow has strategically guided the system’s use of technology to increase access to quality health care, extending care beyond the hospital walls and into the communities where families live, learn and play.
She currently oversees one of the largest and fastest-growing school telemedicine programs in the country, as well as several unique and innovative virtual health programs like Remote Patient Monitoring (RPM), TeleNICU/ER and the development of mobile health applications including My Asthma Pal. The aim of these programs is to improve health outcomes and empower patient families to become active drivers of their own health care.

As a passionate advocate for innovation and technology, she has provided guidance on influential legislation including House Bill 1878, which allows any provider in the state of Texas to be reimbursed for school-based telemedicine. She has also provided outreach and collaboration with national technology and health care organizations including the American Academy of Pediatrics on how to seamlessly integrate technology into health care.

Dr. Hall-Barrow has published research in peer-reviewed journals, presented around the globe on virtual health best practices, and been honored with many notable industry awards. In 2016, she was named one of the Most Powerful Women in Health Care IT by Health Data Management and was honored with the Achievement in Innovation in D CEO’s Excellence in Healthcare Awards.
She is considered a national and international expert in the field of telemedicine, including its use in pediatrics, neurology, emergent delivery methods and health care mobility. Dr. Hall-Barrow is a past chair of the American Telemedicine Association Pediatric Special Interest Group.


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EP-149 - Secondary Cost Savings Associated with School Telehealth

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