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Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries
Kristin N Ray1, Ateev Mehrotra2, Jonathan G Yabes3
1Department of Pediatrics (KN Ray), University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa.
Insights
Telemedicine use in pediatric subspecialty care increased for rural children, but overall utilization remained low. Early policies did not reduce disparities in access to care for children based on location or background.
Area of Science:
- Health Services Research
- Pediatric Subspecialty Care
- Telemedicine Equity
Background:
- State Medicaid programs are increasingly covering live interactive telemedicine.
- The impact of telemedicine on equity in pediatric subspecialty care utilization is unknown.
Purpose of the Study:
- To examine telemedicine use patterns for outpatient pediatric subspecialty care within state Medicaid programs.
- To assess if telemedicine improves equity in access to care.
Main Methods:
- Analysis of 2014 Medicaid data for children (≤17 years) in 12 states.
- Compared telemedicine use between children seeing telemedicine-using and non-using subspecialists.
- Used logistic and negative binomial regression to analyze factors associated with telemedicine use and visit rates.
Main Results:
- Only 0.3% of identified subspecialists had telemedicine claims.
- Rural children and those living farther from subspecialists were more likely to use telemedicine.
- Telemedicine use showed larger disparities in visit rates based on geography and sociodemographics compared to non-telemedicine users.
Conclusions:
- Children in rural areas and those distant from subspecialists had higher telemedicine use likelihood.
- Overall telemedicine utilization was low.
- Current telemedicine policies and implementation have not eliminated disparities in pediatric subspecialty care access.
Objective:
Live interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs.
Methods:
We identified children ≤17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms.
Results:
Of 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8%) had ≥1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3%) had ≥1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those >90 miles from the subspecialist (OR 13.4, 95% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P < .001 for interaction terms).
Conclusions:
Children in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.
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