The use of telehealth in a large community oncology practice prior to and during the COVID-19 pandemic.

Abstract

1631 Background:The COVID-19 pandemic prompted implementation of telehealth services in oncology following CMS approval for reimbursement. Using data from a single large US-based community oncology practice, we characterized the adoption of telehealth, evaluated telehealth’s impact on patient transit to the site of care, and the frequency of ER visits and hospitalizations. Methods: A retrospective cohort analysis was conducted using data from January 2019 through June 2022 from the FCS EMR database, IQSS’s RefineIQ database, which captures and standardizes patient treatments for consistent analysis, InfoDive, a reimbursement platform with data on clinic visits, and Oncology Care Model data. The target population included all patients with cancer aged 18 or older under active management at FCS during the study window with at least 60 days of follow-up. Patient disease and demographic characteristics and ER/hospital care visits were compared between telehealth groups, as well as impact of telehealth use on transit time and distance traveled for patients was summarized using descriptive statistics. Results:178,531 patients were analyzed. Median age was 68, with 64% female and 47% white. 97% of patients lived in a metropolitan area, 97% in Florida, and 77% in areas with less than $78,000 median income. Median duration of disease was 41 months, 24% of patients were stage IV and 93% ECOG 0-1. 20% of patients used telehealth, with 81% having only one telehealth use per year. Patients using telehealth, compared to those that did not, were more likely to be white (50% vs 46%), have commercial insurance (30% vs 27%), live in areas where annual median income was > $78,000 (25% vs 22%) and ≥95% of the population graduated high school (31% vs 26%). Telehealth saved a median of 5 miles driven per user annually. Users tended to have more advanced disease than non-users, with a higher proportion of metastatic disease (27% vs 23%), high CMS risk score (16% vs 15%), and line of therapy 2 or greater (10% vs 7%). Users had higher median annual oncology clinic visits both pre- (5 vs 3) and post-telehealth approval (6 vs 5). Hospital admissions after ER visits were more frequent among users both pre- (14% vs 13%) and post-telehealth approval (29% vs 25%). Conclusions: Telehealth was somewhat more likely to be used by patients with cancer in more affluent communities, white patients, patients who had more advanced disease and more frequent clinic and hospital visits. Most patients who used telehealth used it only once, and the low utilization of telehealth had limited impact on patient transit effort to the clinic. This study is limited by its concentration at a single large practice in Florida, the relatively low use of telehealth, retrospective design, and selection bias, as the telehealth population had more advanced disease and likely needed more frequent intervention.