Referral to Specialized Functional Seizures Clinic Reduces Health Care Costs

Referral to clinic that specializes in functional seizures is related to reduced health care utilization and costs, according to study findings published in Neurology Clinical Practice.

Researchers conducted a retrospective study to evaluate changes in total emergency department (ED) and inpatient visits and costs before and after referral to a treatment clinic that specializes in functional seizures.

Electronic health record data were collected from 100 consecutive adults with a confirmed diagnosis of functional seizures who were referred to the University of Colorado Functional Seizure Clinic between July 2019 and December 2021.

The primary outcomes included total ED and inpatient visits, charges, and payments 1 year before vs 1 year after the referral date, all of which were analyzed using the Wilcoxon signed-rank test.

A total of 94 patients (mean age, 41; women, 79%; Medicaid, 52%; disability insurance, 23%) were enrolled in the study, of whom 53 (56%) had at least 1 documented ED visit and 11 (12%) had at least 1 documented inpatient visit.

Overall, 74 patients completed an intake visit at the University of Colorado Functional Seizure Clinic and 75 patients had a diagnosis of functional seizures without epilepsy.

Mean total visits after vs before referral were significantly reduced (1.44 vs 1.83; P =.045). Similarly, mean total charges ($15,551 vs $30,257; P =.03) and total payments ($2469 vs $5199; P =.02) were also significantly reduced before vs after referral.

No significant differences were observed after vs before referral for visits, charges, or payments among patients who completed an intake visit at the University of Colorado Functional Seizure Clinic.

Among those who had no documented intake visits at the specialized clinic, charges were significantly reduced after vs before referral (P =.035); however, visits (P =.08) and payments (P =.07) were not.

Participants without comorbid epilepsy demonstrated a significant reduction after vs before referral for visits (P =.02), charges (P =.005), and payments (P =.008).

No significant differences between after and before referral visits (P >.05), charges (P >.05), and payments (P >.05) were observed among patients with comorbid epilepsy.

When ED and inpatient visits, charges, and payments were separated, each outcome trended toward a reduction. A significant reduction was observed after vs before referral for inpatient visits (mean, 0.23 vs 0.05; P =.01).

Study limitations include the limited generalizability of results, lack of a control group, and potential bias due to overlap with the COVID-19 pandemic.

“This proof-of-concept study reveals that hospitals should implement policies to support efficient care pathways to comprehensive FS [functional seizure] treatment programs with potential for cost savings,” the study authors concluded.