Referral to a Functional Seizures Clinic Reduces Inpatient and Emergency Department Health Care Utilization and Costs

Meagan R Bean; Meagan M Watson; Mackenzi L Moore; Laura A Strom

doi:10.1212/CPJ.0000000000200393

Referral to a Functional Seizures Clinic Reduces Inpatient and Emergency Department Health Care Utilization and Costs

Neurol Clin Pract. 2025 Feb;15(1):e200393. doi: 10.1212/CPJ.0000000000200393. Epub 2024 Nov 21.

Authors

Meagan R Bean¹, Meagan M Watson¹, Mackenzi L Moore¹, Laura A Strom¹

Affiliation

¹ Colorado School of Public Health (MRB); and Department of Neurology (MMW, MLM, LAS), University of Colorado, Aurora.

PMID: 39600562
PMCID: PMC11588422 (available on 2026-02-01)
DOI: 10.1212/CPJ.0000000000200393

Abstract

Background and objectives: People with functional seizures (FSs) experience high health care utilization and costs revolving around the emergency department (ED). Overall, appropriate treatment of FS is underused, and better care pathways are associated with lower ED reattendance. Our objective was to assess changes in total ED and inpatient visits and costs before and after referral to a specialized, comprehensive FS treatment clinic.

Methods: We collected data from 100 consecutive patients referred to the University of Colorado (CU) FS Clinic between July 2019 and December 2021. Hospital account data were obtained directly from the electronic health record. Total ED and inpatient visits, charges, and payments 1 year before and 1 year after referral were collected and analyzed using the Wilcoxon signed-rank test.

Results: Ninety-four patients were included for analysis. 79% were female, 52% were on Medicaid, and the mean age was 41 (SD 13) years. Total visits after referral (ED and inpatient) were significantly reduced compared with total visits before referral (mean = 1.44 (SD 3.52) vs 1.83 (SD 3.52), p = 0.045). The same test was performed for total charges after and before referral ($15,551 (SD $38,712) vs $30,257 (SD $81,589), p = 0.03) and for total payments after and before referral ($2,469 (SD $6,682) vs $5,199 (SD $15,084), p = 0.02).

Discussion: Referral to a specialized FS clinic is associated with reduced health care utilization and costs. This proof-of-concept study reveals that hospitals should implement policies to support efficient care pathways to comprehensive FS treatment programs with potential for cost savings.