Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation
BackgroundFrontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for spe...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2023-09-01
|
| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2023/1/e49591 |
| _version_ | 1797680150967484416 |
|---|---|
| author | Saira Haque Sydney DeStefano Alison Banger Regina Rutledge Melissa Romaire |
| author_facet | Saira Haque Sydney DeStefano Alison Banger Regina Rutledge Melissa Romaire |
| author_sort | Saira Haque |
| collection | DOAJ |
| description |
BackgroundFrontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions.
ObjectiveWe evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach.
MethodsWe conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program.
ResultsCAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs.
ConclusionsThe frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability. |
| first_indexed | 2024-03-11T23:24:43Z |
| format | Article |
| id | doaj.art-555ba44d8a7b458c91f7271c2c573884 |
| institution | Directory Open Access Journal |
| issn | 2561-326X |
| language | English |
| last_indexed | 2024-03-11T23:24:43Z |
| publishDate | 2023-09-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj.art-555ba44d8a7b458c91f7271c2c5738842023-09-20T13:02:11ZengJMIR PublicationsJMIR Formative Research2561-326X2023-09-017e4959110.2196/49591Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods EvaluationSaira Haquehttps://orcid.org/0000-0001-8866-9005Sydney DeStefanohttps://orcid.org/0000-0001-6835-1147Alison Bangerhttps://orcid.org/0000-0003-3507-8601Regina Rutledgehttps://orcid.org/0000-0001-5703-519XMelissa Romairehttps://orcid.org/0000-0003-0022-0487 BackgroundFrontier areas are sparsely populated counties in states where 65% of the counties have 6 or fewer residents per square mile. Residents access primary care at critical access hospitals (CAHs) located in these rural communities but must travel great distances for specialty care. Telehealth could address access challenges; however, there are barriers to broader use, including reimbursement and the need for practical implementation support. The Centers for Medicare & Medicaid Services implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to assess the impact of telehealth payment change and technical assistance to adopt and sustainably use telehealth for CAHs treating Medicare fee-for-service patients in frontier regions. ObjectiveWe evaluated the impact of the FCHIP Demonstration telehealth payment change and technical assistance on telehealth adoption and ongoing use using a mixed methods approach. MethodsWe conducted a mixed methods evaluation of the 8 CAHs in Montana, Nevada, and North Dakota that participated in the FCHIP program. Key informant interviews and FCHIP program document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators of program adoption and maintenance. Medicare fee-for-service claims were analyzed from August 2013 to July 2019 relative to a group of CAHs that did not participate in the demonstration project to understand the frequency of telehealth use for Medicare fee-for-service beneficiaries receiving care at the participating CAHs before and during the Demonstration program. ResultsCAH staff noted several key factors for establishing and sustaining a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities to deliver telehealth services to patients of CAH. There was a modest increase in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs. ConclusionsThe frontier setting is characterized by a low population; and thus, the volumes of telehealth services provided in both the CAHs and comparison sites are low. Overall, CAHs reported that patient satisfaction was high and expressed the desire for more virtual services. Telehealth service selection was informed by perceived community needs and specialist availability. CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. Implementation support services helped CAHs integrate telehealth into clinical and operational workflows. There was some increase in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work to inform policy and practice could include standardized, formal community need assessments and assistance finding distant providers to meet those needs and further technical assistance around billing, service selection, and ongoing use to support sustainability.https://formative.jmir.org/2023/1/e49591 |
| spellingShingle | Saira Haque Sydney DeStefano Alison Banger Regina Rutledge Melissa Romaire Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation JMIR Formative Research |
| title | Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation |
| title_full | Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation |
| title_fullStr | Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation |
| title_full_unstemmed | Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation |
| title_short | Telehealth Impact in Frontier Critical Access Hospitals: Mixed Methods Evaluation |
| title_sort | telehealth impact in frontier critical access hospitals mixed methods evaluation |
| url | https://formative.jmir.org/2023/1/e49591 |
| work_keys_str_mv | AT sairahaque telehealthimpactinfrontiercriticalaccesshospitalsmixedmethodsevaluation AT sydneydestefano telehealthimpactinfrontiercriticalaccesshospitalsmixedmethodsevaluation AT alisonbanger telehealthimpactinfrontiercriticalaccesshospitalsmixedmethodsevaluation AT reginarutledge telehealthimpactinfrontiercriticalaccesshospitalsmixedmethodsevaluation AT melissaromaire telehealthimpactinfrontiercriticalaccesshospitalsmixedmethodsevaluation |