619 - Quantifying the non-billable workload of Outpatient Parenteral Antibiotic Therapy (OPAT) services in a University Infectious Diseases (ID) Clinic

Background: OPAT service has health and economic benefits for the patient, health care facility and the general community.  Management of patients receiving OPAT requires an interdisciplinary team approach and complex care coordination and has been shown to decrease adverse reaction, and rehospitalizations.  Much of the work involved in caring for patients on OPAT occurs outside of a billable office visit.  Describing and quantifying this workload is important to justify staffing and to advocate for change in reimbursement structure.

Methods: Patients enrolled in OPAT program at our clinic in 2019 were identified from the electronic medical record (EMR) and information was extracted on all EMR encounters by ID faculty and staff occurring from the start of OPAT monitoring until 14 days after OPAT ended, or until March 31, 2020 for patients still on OPAT on that date. 

Results: During 2019, 835 unique OPAT courses were monitored for 767 patients. Activities include a sign-on process, monitoring labs, drug levels, coordinating care, weekly review by OPAT team (Medical Director or an ID attending, nurse practitioner (NP), nurse (RN) and ID pharmacist).  We identified 7,640 encounters; 1,072 were office visits.  Thus, 86% (N=6569) of encounters were for managing and coordinating care. The OPAT RN created 3435 of 6568 (52%) encounters, 2034 (31%) were by physicians and nurse practitioners, 500 by other clinic RNs and 599 were by administrative staff

Conclusion: Our results quantify the immense care for OPAT patients that is not compensated by insurance. However, this work contributes to patient safety and satisfaction.  Our data does not account for time spent by the multidisciplinary team on weekly review of all active OPAT patients which lasts about 3 hours and is essential to ensuring patient safety. This data also does not quantify the contribution of the ID pharmacist who is consulted by OPAT team for multiple issues but whose recommendations are documented by the providers. The total time involved in all this work could not be determined.  The quantification of the uncompensated workload of such monitoring is important as it can be justification for modernization of reimbursement for OPAT patient care, making the establishment and maintenance of such programs more financially solvent for health care organizations.