Older adults, minorities and individuals with lower salaries face disparities in telemedicine use

Overview

• Post By : Kumar Jeetendra


• Source: University of Pennsylvania School of Medicine


• Date: 31 Dec,2020

After”COVID-19,” the word which most people will remember best from 2020 is very likely to be”social distancing.” While it most commonly applied to social gatherings with family and friends, it has changed how many receive medical attention.

However, the COVID-19 pandemic, particularly in the spring of 2020, required increased use of virtual or telephone call visits, even prompting the Center for Medicare and Medicaid Services (CMS) to relax some of its regulations, primarily for video-based telemedicine. These large scale changes made telemedicine exponentially more popular than it was even at the start of the calendar year.

But while this was a positive for those who otherwise would have delayed or foregone attention because of the pandemic, a new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania, published in JAMA Network Open, found significant inequities, particularly by race/ethnicity, socioeconomic status, age, and when someone required to use a language other than English.

“As we begin to establish novel methods of caring for our patients through telemedicine, it is vital that we make the basis of this new way forward honorable,” said the study’s senior author, Srinath Adusumalli, MD, an assistant professor of Cardiovascular Medicine and the University of Pennsylvania Health System assistant chief medical information officer for connected wellness. “We hope that regulatory and payer organizations recognize potential inequities that could be introduced by policies they create — that may include not reimbursing for telephone visits, and potentially leading to lack of access to care for particular patient populations, especially those disproportionately affected by events like the COVID-19 crisis.”

The researchers, who included the study’s lead author, Lauren Eberly, MD, a clinical fellow in Cardiovascular Medicine, examined data for nearly 150,000 patients of a large, academic medical system. All these patients were previously scheduled to have a primary care or ambulatory specialty trip between March 16 and May 11, 2020. This time period coincided with the first surge of coronavirus in the health system’s region, and was likewise amid stay-at-home orders in the region.

Of the patients who had visits previously scheduled, a little more than half, roughly 81,000 (54 percent), conducted their visits via telemedicine, the data showed. And within that section, less than half, nearly 36,000, (46 percent) had visits conducted through video.

When these visits were broken down from the patients’ characteristics, some apparent inequities were found. In general, patients who were older than 55 were 25 percent less likely than the average individual to successfully participate in a telemedicine visit, with people older than 75 becoming 33 percent less likely. Individuals who identified as Asian were 31 percent less likely to conduct a telemedicine visit, and people who didn’t speak English were 16 percent less likely.

Due to the comfort of CMS rules surrounding video-based telemedicine early in the pandemic, it’s important to consider that style of telemedicine in a class by itself. So when those numbers were examined, a number of the same groups showed even less positive numbers than they had for overall telemedicine use. For instance, people over 55 were 32 percent less likely to conduct a video visit, with those over 75 being 51 percent less likely.

Meanwhile, some groups of individuals were demonstrated to have significant disparities in video-based telemedicine even if they had not displayed them for overall telemedicine use. This probably means that they did not have problems accessing telemedicine if it had been telephone or audio-based, but video was much less accessible to them. More, women were 8 percent less likely to participate in a video visit than men, Latinx patients were 10 percent less likely than White patients, and Black people 35 percent less likely than White people. Patients with lower family incomes were less likely to conduct a video visit, with those making less than $50,000 being 43 percent less likely.

One concrete thing that has already been addressed, based on the results of this study, was adding one-click interpreter integration for more than 40 video-based languages and greater than 100 audio-based languages for both inpatient and outpatient telemedical care throughout our enterprise.”

Lauren Eberly, MD, Clinical Fellow in Cardiovascular Medicine

While the CMS has just tried to make phone call-based telemedicine easier to get from a reimbursement standpoint, the researchers believe their findings reveal that there needs to be equal consideration for all forms of telemedicine moving ahead.

“It is crucial that complete payment parity for all types of telemedicine visits, by all insurance payers, is ensured permanently,” Eberly said. “Less reimbursement for telephone visits may disproportionately and unjustly harm clinics and providers that care for poorer and minority patients.”

Penn Medicine has long implemented a practical approach to root out technical issues that may play a role in access issues. Specifically, professionals within the health system work with patients to assess if they have the technical ability to successfully have a trip. Including checking Wi-Fi speed and if the patient has apparatus physically capable of conducting the trip.

Something since the start of the COVID-19 outbreak that Adusumalli said Penn Medicine addressed was the inequity found for non-English speakers.

Moving forward, the researchers hope they can find more ways to make telemedicine work for everyone, such as facilitating broadband and electronic device access.

“If we can understand these obstacles, it could help direct telemedicine implementation strategies that will benefit everyone.”