JMIR Publications

ABSTRACT

Background:

Frontier areas are located in counties with six or fewer residents per square mile where 65 percent of the state counties have six 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. Increasing telehealth use may address access challenges. The Center for Medicare and Medicaid Services (CMS) implemented the Frontier Community Health Integration Project (FCHIP) Demonstration to test the impact of a telehealth payment change and technical assistance to adopt telehealth for CAHs treating Medicare fee-for-service patients in frontier regions.

Objective:

We assessed the impact of the FCHIP Demonstration telehealth payment change on telehealth adoption.

Methods:

We conducted a mixed-methods evaluation of 8 CAHs in Montana, Nevada, and North Dakota that received the payment change. Key informant interviews and CAH document review were conducted and analyzed using thematic analysis to understand how CAHs implemented their telehealth programs and the facilitators to program adoption and maintenance. Medicare fee-for-service claims were analyzed from August of 2013 and July of 2019 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.

Results:

CAH staff noted several key factors for establishing a telehealth program: clinical and administrative staff champions, infrastructure changes, training on telehealth processes, and establishing strong relationships with specialists at distant facilities deliver telehealth services to CAH patients. There were modest increases in telehealth services billed to Medicare during the FCHIP Demonstration that were limited to a handful of CAHs.

Conclusions:

CAHs made infrastructure changes to support telehealth and expressed the desire for more virtual services. There were some increases in telehealth services billed to Medicare, but the volume billed was low and not enough to substantially improve hospital revenue. Future work could include standardized, formal community needs assessments and assistance finding distant providers to meet those needs.