Year: 2019
Type: article
Study design: Observational Study
Abstract: Accountable care organizations (ACOs) aim to improve healthcare quality and reduce spending.Telemedicine, or the remote delivery of healthcare services using a variety of telecommunications devices, offers the potential to advance these goals by expanding patients' timely access to care, reducing costs, and enabling better coordination of care among providers and care settings (1).Recognizing the potential value telemedicine offers to ACOs, the Centers for Medicare & Medicaid Services (CMS) provided fraud and abuse waivers protecting ACO participants who share in the costs of telemedicine services.CMS is now proposing additional changes to the Medicare Shared Savings Program to further accelerate telemedicine use (2).While Medicare policy to promote telemedicine has largely focused on ACOs, the current use of telemedicine by ACO providers is unknown.Therefore, we aimed to examine the impact of Medicare Shared Savings Program ACO policy initiation on the use of telemedicine for evaluation and management services provided to Medicare beneficiaries.Using claims from a 20% national sample of fee-forservice Medicare beneficiaries and the Medicare Shared Savings Program ACO research identifiable file, we identified all evaluation and management visits from 2009 through 2015 performed by ACO and non-ACO providers.We defined telemedicine visits as those with a telemedicinespecific Current Procedural Terminology code (G0425-7, G0406-8, G0459) or modifier (GT, GQ).We calculated the proportion of total evaluation and management visits that utilized telemedicine for ACO and non-ACO providers, by year of service.We used a Pearson's chi-squared test to assess the relationship between ACO-participation and telemedicine use.To evaluate the impact of ACO policy initiation, we performed an interrupted time-series analysis.The dependent variable was use of telemedicine during an evaluation and management visit.We estimated a logistic model with quarterly linear splines after ACO initiation, adjusted for clustering at the provider level.A P value of less than 0.05 was considered significant.Statistical analyses were conducted using Stata 15.1 (College Station, TX, USA).This study was deemed exempt from review by the institutional review board.This work was supported
Source: mHealth
Institution: University of Michigan
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2925498862