Data source: Encounter data collected by telemedicine site coordinators.

As stated previously, telemedicine site coordinators collected and entered a variety of information for each telemedicine encounter. These data included the following information:

• Date and time of each patient’s telemedicine encounter, including time begun and time concluded.

• Specialty of the consulting physician.

• Likely action if the telemedicine encounter had not occurred (that is, the health service administrator’s judgment about what alternative care would have been provided).

• Subsequent care required (namely, the specialist’s orders for patient care).

Monthly downloads of electronic encounter forms provided these data.

Telemedicine Encounters: Costs

Unit costs of telemedicine encounters contain many elements.

Physician reimbursement. The Department of Veterans Affairs negotiated an hourly reimbursement rate for specialists providing care telemedically. The rate reflected the actual cost to the VA of a physician’s salary plus expenses. The duration of each encounter in minutes was multiplied by the per-minute cost of the relevant specialist. For telepsychiatry encounters, where Bureau-employed psychiatrists at FMC-Lexington were providing care, psychiatrists’ salaries, fringe benefits, and bonus payments were calculated at the hourly and per-minute level.

Equipment, personnel, and telecommunications costs. Tracor Systems Technologies, Inc., supplied costs of equipment leases, personnel (for example, site coordinators), and communications. These costs included hub and remote costs because both were necessary for each telemedicine encounter. These costs were calculated for each site at the hourly and per-minute level and multiplied by the duration of each telemedicine encounter.

Security/escort. Inmates from FCI-Allenwood were transported to USP-Allenwood for telemedicine sessions. This involved the same security and approval process as an external specialist encounter, although the escort array was minimized because the necessary guards on the transport bus were moving a number of inmates at the same time.

Other. A physician assistant accompanied each patient during an encounter, as was done for internal specialist encounters, and performed other tasks such as pulling and refiling medical records.