Evidence of hospital‐based HIT infrastructure and reduced Medicare payment and racial and ethnic disparities among ADRD patients

Abstract

AbstractBackgroundUnderstanding the potential cost‐saving or cost‐enhancing of HIT adoptions can help policymakers understand the capacity of HIT investment for population health and racial and ethnic groups. The objective of the study is to examine access to the hospital‐based HIT infrastructure and its association with Medicare payments by Alzheimer’s disease and related dementia (ADRD) patients’ racial and ethnic groups. ADRD is one of the most expensive health conditions in the Unites States and substantial racial and ethnic disparities are observed.MethodWe used 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Annual survey. Generalized linear models were used for the payment regressions.ResultsThe adjusted total Medicare payment and acute inpatient Medicare payment per person per year were higher for ADRD beneficiaries treated in hospitals with telehealth‐post discharge functions (e.g., an incremental increase of $542 in total payment). However, it relates to a significant reduction of Medicare payments to Black ADRD patients (approximately a reduction of $1,104). The finding suggested that telehealth‐post discharge might be cost‐enhancing at the population level; however it is cost‐saving to Black patients with ADRD. The cost‐saving of Black patients exceeded the incremental cost of the adoption of HIT‐post discharge. Similar findings were found for the telehealth‐treatment, which was associated with a significant reduction of payments among Black and Hispanic ADRD patients.ConclusionsResults suggested that personalized HIT utilization and provisions (telehealth‐post‐discharge for Black and telehealth‐treatment for Black and Hispanic ADRD patients) are critical components of receiving high‐quality ADRD treatment for minority patients.