Telemedicine use by medicare beneficiaries undergoing hepatopancreatic surgery during COVID-19

Abstract

Background: The COVID-19 pandemic has played a substantial role in exacerbating pre-existing disparities in access to surgical care. In particular, vulnerable communities have not been able to avail the benefits of telemedicine facilities under the Medicare coverage waiver. We sought to explore the trends and predictive factors associated with telemedicine use. Methods: Patients who underwent hepatopancreatic (HP) surgery between 2013-2020 were identified from the Medicare Standard Analytic Files (SAF). The utilization of telemedicine was quantified after the implementation of the Medicare telemedicine coverage waiver, and data on the county-level social vulnerability index (SVI) were procured from the Centers for Disease Control/Agency for Toxic Substances and Disease Registry. Interrupted time series analysis and multivariable logistic regression were used to assess the association of SVI with telemedicine use. Results: After the waiver, a total of 3,031 patients underwent hepatic (n=1,199, 39.6%), pancreatic (n=1,378, 45.5%) or both surgeries (n=454, 15.0%). The median age was 70 (IQR 66-74), with a majority being female (n=1,599, 52.8%), White (n=2,641, 87.1%), and having a high comorbidity burden [Charlson Comorbidity Index (CCI) >2; n=1,544, 51.3%]. Most patients resided in counties characterized by intermediate social vulnerability [SVI, low: 10.62% (n=322); moderate: 63.84% (n=1,935); high: 25.54% (n=774)]. After the implementation of the waiver, 45.8% (n=1,388) of patients participated in at least one outpatient telemedicine visit. Telemedicine use in the post-waiver period peaked in May 2020 and varied relative to SVI (Low SVI: n=150, 46.58% vs. moderate SVI: n=937, 48.42% vs high SVI: n=301, 38.89%, p2 (referent ≤2; OR 1.49, 95% CI 1.28-1.71) were more likely to use telemedicine (all p< 0.001). Conclusion: These results indicate that patients who lived in highly vulnerable counties and the elderly were less like to have access to telemedicine facilities, while Black patients and those with a high comorbidity burden were more likely to utilize telemedicine. With an ever-increasing dependence on healthcare technology, policies that ensure equitable access to digital resources are required.