Reimbursement patterns and user experiences in pediatric allergy home telehealth

Methods of Reimbursement for Telemedicine Services: A Scoping Review

Background: With the advent of coronavirus-2019 (COVID-19), telemedicine services have played an essential role in reducing the transmission of this virus between patients and health care providers. Nevertheless, financial and reimbursement barriers are the biggest challenge in adopting these technologies. It seems necessary to determine the successful reimbursement methods in different countries. The purpose of this study was to identify methods of reimbursing telemedicine services.

Methods: A search without time limitation was conducted on the PubMed, Web of Science, and Scopus databases in December 2020 and updated in January 2022. Articles were identified using predefined inclusion and exclusion criteria. Two researchers independently evaluated the titles, abstracts, and full text of the articles.

Results: Out of 4946 identified articles, 28 articles were included. In these studies, the most used insurances were Medicare (n = 17), and Medicaid (n = 15). The majority of services included telepsychiatry (n = 7), telehealth (n = 7), and telemedicine (n = 7). There was no difference between the reimbursements in telemedicine services and face-to-face visits in 18 studies.

Conclusion: Various government, state, and private insurance reimbursed telemedicine services. In most studies, there was no difference between reimbursing telemedicine services and in-person visits. Differences in the type and number of reimbursements may be due to the year of publication of the articles, changes in covered service policies, and state laws. Because of the COVID-19 pandemic, it is crucial to develop and update the guidelines and regulations for telemedicine reimbursement. Future studies can examine the telemedicine reimbursement methods in developed and developing countries before and after the COVID-19 pandemic.

Do Medical Insurance Companies Reimburse Telemedicine Office Visits the Same as In-Person Office Visits in an Academic Oral and Maxillofacial Surgeon Setting?

PURPOSE

The use of telemedicine has grown exponentially over the last decade, but its widespread adoption has been hindered, at least in part, by uncertainty over reimbursement rate for services. The aim of this study is to compare reimbursement rates of telemedicine and in-person visits in an academic oral and maxillofacial surgery practice.

METHODS

The investigators implemented a retrospective cohort study. The sample was composed of patients who were treated by the oral-maxillofacial surgery service at the University of Pennsylvania Health System from March 17, 2020 to February 27, 2021. The primary predictor variable was the type of patient visit, either telemedicine or in-person. Patient status, either established or new, was a covariate. The outcome variable was the mean reimbursement-to-charge (RC) ratio. Descriptive and bivariate statistics were computed, and the P value was set at .05.

RESULTS

This study included 6,082 submitted claims for 4,045 patients for in-person and telemedicine oral-maxillofacial surgery office visits. The mean reimbursement per insurance payor was $98.07 for a telemedicine visit (mean RC ratio = 0.48 with a standard deviation of ± 0.20) and $109.5 for an in-person visit (mean RC ratio = 0.50 with a standard deviation of ± 0.19). While there was a significant difference between the RC ratio for total telemedicine versus in-person visits (P = .001), the magnitude of the difference was only 2%. When stratifying the comparison by new (P = .73) and established patients (P = .20) for both telemedicine and in-person office visits, there was no significant difference in RC ratios.

CONCLUSIONS

The results suggest that there are no major discrepancies in financial reimbursement rate between telemedicine and in-person office visits. Both methods of treatment may be financially effective for oral-maxillofacial surgery providers. Future studies can compare reimbursement rates among different insurance providers and among different institutions in the United States.

Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study

Background

The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion.

Objective

We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan.

Methods

Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020.

Results

Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period.

Conclusions

In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic.