Association of Emergency Department Payer Mix with ED Receipt of Telehealth Services: An Observational Analysis

• Main Authors: Boggs, K.M (Author), Camargo, C.A (Author), Hayden, E.M (Author), Li, S. (Author), Samuels-Kalow, M.E (Author), Zachrison, K.S (Author)
• Format: Article
• Language: English
• Published: eScholarship 2022
• Subjects: adult; article; controlled study; Emergency Service, Hospital; emergency ward; hospital emergency service; hospital patient; human; Humans; investment; male; medicaid; Medicaid; New York; rural population; Rural Population; telehealth; telemedicine; Telemedicine; United States; vulnerable population; Vulnerable Populations
• Online Access: View Fulltext in Publisher

 Introduction: Telehealth is commonly used to connect emergency department (ED) patients with specialists or resources required for their care. Its infrastructure requires substantial upfront and ongoing investment from an ED or hospital and may be more d ifficult to implement in lower-resourced settings. Our aim was to examine for an association between ED payer mix and receipt of telehealth services. Methods: Using data from the National Emergency Department Inventory (N EDI)-USA 2016 survey, we categorized EDs based on receipt of telehealth services (y es/no). The NEDI-USA data for EDs in New York state was linked with data from state ED datasets (SEDD) and state inpatient data (SID) to determine EDs' payer mix (percent self-pay or Medicaid). Other ED characteristics of interest were rural location, academic status, and annual ED visit volume. We compared EDs with and without telehealth receipt, and used a logistic regression model to examine the relationship between ED payer mix and telehealth receipt after accounting for other ED characteristics. Results: Of the 162 New York EDs in the SEDD-SID dataset, 160 (99%) were linked to the NEDI-USA dataset and 133 of those responded (83%) to the survey . Telehealth receipt was reported by 48 EDs (36%, 95% confidence interval [CI], 28-44%). Emergency departments with and without telehealth receipt were similar (all P >0.40) with respect to rurality (6% vs 9%, respectively), academic status (13% vs 8%), and annual volume ( median 36,728 vs 43,000). By contrast, median percent of Medicaid or self-pay patients wa s lower in telehealth EDs (36%) vs non-telehealth EDs (45%, P = 0.02). In adjusted analysis, increasing proportion of Medicaid and self-pay patients was associated with decreased odds of tel ehealth receipt (odds ratio 0.87 per 5% increase; 95% CI, 0.77-0.99). Rural location, academic s tatus, and ED volume were not significantly associated with odds of ED telehealth receipt in t he adjusted model. Conclusion: Among EDs in the state of New York, increasing proportion of self-pay and Medicaid patients was associated with decreased odds of ED telehealth receipt, even after accounting for rural location, academic status, and ED volume. The findings support the need for additional infrastructural investment in EDs serving a greater proportion of disadvantaged patients to ensure equitable access. © 2022 Zachrison et al.