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The Value of an ID Specialist

By Amesh A. Adalja, MD, FACP, October 11, 2013

In general, the financial value of inpatient physician services is derived from billable actions (procedures and admissions) that generate revenue for hospitals and other healthcare facilities. However, some specialties and subspecialties are primarily cognitive in nature, and their practitioners do not regularly perform billable procedures. Infectious disease (ID) is one such specialty. The primary intervention of an ID physician is to examine a patient, review records and test results, and think about the patient’s illness in order to delineate probable diagnoses, focus further testing, and prescribe a course of treatment. The nature of ID specialty work sometimes makes it difficult to provide an economic estimate of the value added by ID consultations; however, a recent study published in Clinical Infectious Diseases clarifies the value for patients and hospitals.1

Reduced Mortality and Readmission

Using a database of Medicare claims data from 2008-2009, Schmitt and colleagues identified 125,000 hospitalized patients who were diagnosed with one or more of the following infections: bacteremia, Clostridium difficile infection, central line associated bloodstream infection, bacterial endocarditis, HIV, meningitis, osteomyelitis, septic shock, or vascular device infection. To quantify the impact of ID consultation, the researchers created matched cohorts that paired patients who did and did not receive ID consultation.

Analysis of the patient data revealed that ID consultation had several important benefits, including lower rates of in-hospital mortality (OR 0.87), 30-day mortality (OR 0.86), and 30-day readmission (OR 0.96). Additionally, when ID consultation was obtained within 2 days of admission, mortality and readmission rates and ICU length of stay were all significantly lower than when ID consultation was obtained later. (It would be interesting to know which of the 11 conditions benefitted the most from ID consultations; perhaps future studies will address that question.)

Patient Care Dividends

This study provides further evidence that when ID consultation is sought, it pays patient care dividends that are magnified when sought early in a patient’s hospitalization. While the mortality benefit of ID consultation provides reason enough for routine adoption, the impact on readmission is also important. In an era in which readmissions are being highly scrutinized, hospitals should pursue all interventions that minimize readmission. (Although pneumonia--one of the readmission targets--was not explicitly included in Schmitt’s study, the patients with bacteremia and septic shock likely included some patients with pneumonia.)

Coupled with earlier studies that have shown or implied the benefit of ID consultation for patients with Staphylococcus aureus bacteremia2 and HIV,3 this study confirms the value of the ID consult for patients and provides crucial data for hospitals in assigning economic value to the work of ID consultants.

References

  1. Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis 2013; epub ahead of print September 25, 2013. http://cid.oxfordjournals.org/content/early/2013/09/24/cid.cit610.short. Accessed October 9, 2013.
  2. Honda H, Krauss MJ, Jones JC, et al. The value of infectious diseases consultation in Staphylococcus aureus bacteremia. Am J Med 2010. 123:631-637.
  3. Rao N, Patel V, Grigoriu A, et al. Antiretroviral therapy prescribing in hospitalized HIV clinic patients. HIV Med. 2012: 367-371.