289EMF Are State Telemedicine Parity Laws Associated With Greater Uptake of Telemedicine in the Emergency Department?

Abstract

Telemedicine may improve access to specialists and clinical outcomes. In an effort to increase use of telemedicine, almost half of all states have passed telemedicine parity laws which require insurers to reimburse for telemedicine visits. Our objective was to determine if there is an association between such laws and use of telemedicine in the emergency department (ED). Building on prior research, we determined each states’ telemedicine policy environment as of January 2016. States were divided into those with any form of telemedicine parity law (conditional mandate, non-conditional mandate, or requirement for full parity in payment by private payers) and those without. As part of the 2016 National ED Inventory (NEDI)-USA survey, we surveyed the directors of all 5,381 EDs on the use of telemedicine with the question, “Does your ED receive telemedicine services for patient evaluation? Yes/No.” We assessed the association between a telemedicine parity law and use of telemedicine with a hierarchical logistic regression model controlling for a number of ED characteristics (annual total and pediatric visit volumes, academic status, freestanding ED, U.S. region, and rural/urban location); state was included as a random intercept. In 2016, among the 50 states and the District of Columbia (DC), 21 (41%) had a telemedicine parity law while 30 (59%) did not. Among the 4,419 respondents to the telemedicine question, (82% response rate), 2,125 (48%) used telemedicine. The proportion of EDs using telemedicine varied widely across the states and DC ranging from 13% in DC to 89% in Maine. In unadjusted analyses, there was no difference between the use of telemedicine in EDs in states with and without telemedicine parity laws (55% vs. 53%, p=0.17). After accounting for baseline ED characteristics, there was also no association between state policy environment and ED use of telemedicine, though telemedicine use did vary significantly by state (Table). Many states have adopted parity laws to encourage use of telemedicine. Surprisingly, we found no association between the presence of these laws and use of telemedicine in the ED. These results suggest that other factors are driving the wide variation in ED adoption of telemedicine across states.TableEmergency Department (ED) Characteristics Associated with Receipt of TelemedicineOdds Ratio95% Confidence IntervalAnnual ED volume(per 10,000patient increase)0.980.95-1.02Annual pediatric volume(reference: <3,000)Annual pediatric volume>3,0001.661.40-1.98Annual pediatric volume unknown1.461.18-1.81Academic0.360.25-0.53Freestanding ED0.480.38-0.61Region (Reference: Northeast)Region Midwest0.690.36-1.35Region South0.610.32-1.16Region West0.810.41-1.58Rural1.200.99-1.44Telemedicine parity law1.040.67-1.62Random intercept: state0.690.55-0.88 Open table in a new tab