Interdisciplinary Team Evaluation: A Cost and Time Effective Method for the Clinical Assessment of Autism Spectrum Disorder

Background: Diagnostic evaluations for autism spectrum disorder (ASD) follow a range of processes that can be lengthy and contribute to long wait times for an evaluation. Focusing on essential features of diagnostic evaluations may create a more streamlined process at diagnostic centers, thereby alleviating wait times. At the Seattle Children’s Autism Center (SCAC), we developed an interdisciplinary team evaluation model with two providers of different disciplines, allowing two patients to be evaluated in a single day (Figures 1 and 2). We previously reported commensurate family satisfaction and ASD diagnostic rates across three evaluation models: Team evaluation, Psychology only, and Physician only (Gerdts, et al., 2016). However, differences in actual reimbursement rates and billing times have been unexamined.

Objectives: To compare reimbursement rates and billed hours in Team evaluations versus more traditional ASD diagnostic evaluation methods.

Methods: Sixty-one patients who completed diagnostic evaluations at the SCAC were randomly selected to examine actual reimbursement amounts and billed time for full diagnostic evaluations (excluding an initial triage appointment). Patients were evenly distributed across evaluation types (n=18 for Team, n=21 for Psychologist, and n=22 for Physician). Fifty-three percent of patients had Medicaid and 47% had a commercial insurance plan, with no differences in insurance types across evaluation types (p=.94). Billed hours were determined by summing the time implied by the billing codes associated with the diagnostic evaluation. Net clinic hourly income for evaluations was estimated by calculating the difference between hourly reimbursement rates and average hourly salary rates for provider types at SCAC in the various evaluation tracks.

Results: Given the large discrepancy between Medicaid and commercial insurance reimbursement rates for evaluation, (t(59)=-6.57, p<.001), insurance type was entered as a covariate in analyses of variance. After controlling for insurance type, there were no significant differences in reimbursement rates across diagnostic tracks (p=.59). However, there were large differences in billed time, F(2, 58)=28.35, p<.001 with Teams billing significantly fewer hours than Psychologists only and significantly more than Physicians (Mean=4.5, 6.2, 3.0 hours, respectively for Team, Psychologist, and Physician tracks, p<.005). After controlling for insurance type, there were significant differences in hourly net income across diagnostic tracks, F(2,57)=29.39, p<.001, with highest clinic income for the Physician track (Mean net income=$142.49 per hour), followed by Teams (Mean=$92.37), followed by Psychologists (Mean=$24.30).

Conclusions: ASD Interdisciplinary Team Evaluations appear to be an efficient method for completing ASD diagnostic evaluations while still incorporating gold standard diagnostic tools (e.g., ADOS-2, caregiver interview), without detriment to family satisfaction and while maintaining consistency in diagnostic rates (as reported previously, Gerdts, et al., 2016). Team evaluations result in significantly fewer billed hours (nearly 2 hours less) than a traditional psychology-only evaluation, and generate more income relative to average provider salary when taking actual reimbursement rates into account. In ASD diagnostic centers employing a variety of providers, team evaluations focusing on ruling-in/ruling-out ASD may be an efficient and cost-effective method for conducting ASD diagnostic evaluations, likely beneficial in decreasing wait times thus expediting family’s access to services that are often contingent on an ASD diagnosis.