659 Optimizing Telehealth technology in Sleep Medicine at a VA Medical center during the COVID19 pandemic

Konikkara, John; Kabir, Arif; David, Robert; Donovan, Lucas; Palen, Brian

INTRODUCTION: The COVID19 pandemic poses an unprecedented challenge for healthcare delivery. Optimization of resources and safety of patients and healthcare workers is crucial. The aim of this study is to analyze impact on resource utilization at VA Maryland Healthcare System (VAMHCS). At the pandemic onset, we deployed a mail-in store-and-forward technology (SFT) for carrying out home sleep apnea testing (HSAT), using WatchpatDirect® Peripheral Arterial Tonometry-based testing. This led to a substantial decrease in reliance on care in the community (CITC) or out-of-VA care, resulting in fiscal savings. Interpretation of studies is done by VA physicians using a cloud-based network, resulting in improved workforce optimization and continuity of care. METHODS: We compared CITC expenditures for sleep studies in financial year (FY) 2019 (October 2018 to September 2019) with that of FY2020 in the VA Support Service Center Capital Assets (VSSC) database. RESULTS: In FY2019, VAMHCS conducted 402 polysomnograms, 805 HSATs and referred 64 patients to CITC, including 5 HSATs, with CITC costs of $102,388. CITC referral initiated by primary care providers often resulted in clinic visit and polysomnography (PSG). In FY2020, VAMHCS conducted 436 PSGs, 986 HSATs and referred 10 patients to CITC, including 3 HSATs, costing $6,780; a decrease of $95,608 compared to FY2019. The ratio of VA to CITC studies was 18:1 in FY2019, compared to 142:1 in FY2020. VAMHCS conducted 166 HSATs between 3-15-2020 and 6-30-2020, while the sleep lab was closed due to COVID surge, at a cost of $160 per study. According to VSSC data, an average of $1,005 is spent per patient (including a third-party administrator fee of $200) when utilizing CITC. Approximately 80% of CITC referrals underwent PSG. If all studies were done using CITC, it would have cost an additional $ 140,270. The cost would have been $546, 855 if all studies done between 3-15-2020 and 9-30-2020 were done through CITC. CONCLUSION: The use of SFT during the pandemic resulted in VAMHCS relying less on CITC, leading to a decrease in expenditure, administrative burden and turnaround time. SFT minimizes the risk of infection transmission because PAT probes are disposable and obviates patient visits to the hospital. Support (if any):