Abstract
BackgroundPrior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. To our knowledge, a larger-scale, national-level (US) study has yet to be conducted on the causal impacts of hospital telehealth adoption as well as discontinuation.ObjectiveThe aim of this study is to understand the causal impact of US hospital telehealth adoption or discontinuation on hospital performance from 2016 to 2018.MethodsWe analyzed impacts of telehealth adoption or discontinuation by US hospitals on emergency department visits, total ambulatory visits (minus emergency department visits), outpatient services revenue, total facility expenses, and total hospital revenue for the 2016-2018 period. We specifically focused on performance effects for hospitals that switched from not having telehealth to adopting telehealth, or vice versa, during the 2016-2018 period, thus exploiting 2 quasi-natural experiments. We applied a difference-in-differences research design to each of the 2 main analyses. We compared hospitals that have made a telehealth change to groups of hospitals with similar characteristics that did not make a telehealth change, which established a counterfactual. To appropriately match hospitals between treatment and control groups, we applied propensity score matching. Our primary data were from the American Hospital Association Annual Survey and the Healthcare Cost Report Information System data. Several control variables were obtained from additional sources, including the Area Health Resource File and the Federal Communications Commission.ResultsWe found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P<.001), and increased hospital revenue (P=.004) compared with the control group. We found that telehealth discontinuation during the same period resulted in, on average, decreased outpatient services revenue (P=.02) compared with the control group.ConclusionsOur findings suggest that telehealth adoption increases use but has mixed impacts on performance, given that cost and revenue increase. However, once telehealth is offered, removing it can have a negative impact on performance, implying that returning to prior performance levels, if telehealth is removed, may be challenging.
Highlights
BackgroundTelehealth, in the form of video visits between health care providers and patients, is used by hospitals and their affiliated clinics to maintain or improve access to postdischarge follow-up, continuity of care, and care for nonurgent issues [1,2,3,4,5]
A number of studies have evaluated the impacts of telehealth on outcomes [2,6,7,8,9,10], such studies have primarily focused on either the determinants of telehealth adoption [11] or effects of telehealth primarily for patient populations limited to specific hospital systems or regions [4,12,13,14]
We considered impacts of telehealth adoption or discontinuation during this period on emergency department (ED) visits, total ambulatory visits, outpatient services revenue, total facility expenses, and hospital revenue
Summary
BackgroundTelehealth, in the form of video visits between health care providers and patients (telehealth, ), is used by hospitals and their affiliated clinics to maintain or improve access to postdischarge follow-up, continuity of care, and care for nonurgent issues [1,2,3,4,5]. Many view telehealth with optimism, we do not yet fully understand the impact on hospital-level outcomes when telehealth is adopted or, in the case of challenges, discontinued. When offering video-based consultations to patients, it is possible that increased access to health care increases provider costs and the number of visits requested by patients, which can result in less revenue, especially if telehealth is reimbursed at a lower rate than in-person visits [3]. Prior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. Results: We found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P
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