Utilization of Telemedicine for Patients Receiving In-center Hemodialysis in the United States.

Abstract

BACKGROUND In March 2020, responding to the COVID-19 pandemic, federal emergency waivers in the United States enabled kidney care providers (nephrologists and advanced practice providers) to substitute face-to-face in-center hemodialysis visits with telemedicine encounters. We examined whether the frequency of kidney care provider visits and hospitalizations were associated with telemedicine use in hemodialysis care. METHODS We used Medicare claims to identify US patients receiving in-center hemodialysis during the first 16 months of the COVID-19 pandemic. We examined the association between telemedicine use during in-center hemodialysis, the frequency with which kidney care providers visited patients at dialysis four-or-more times per month, and hospitalizations. We also examined whether the association between telemedicine use and visit frequency varied at facilities located in more remote areas. Multivariable regression models adjusted for patient, physician, geographic and dialysis facility characteristics along with the frequency with which kidney care providers saw patients at each facility before the pandemic. We focused on kidney care providers who demonstrated knowledge of how to bill for telemedicine visits by using the telemedicine modifier on prior claims. RESULTS We identified 1,881 providers who saw patients between 3/2020-6/2021 and were definitively using telemedicine. In the adjusted model, a 35% absolute higher use of telemedicine at a facility (representing one standard deviation difference) was associated with a 1.4% higher rate of four-or-more visits (Incidence Rate Ratio (IRR) 1.014; 95% Confidence Interval 1.007-1.022). The association between telemedicine use and visit frequency was stronger where travel distances to facilities were farther (interaction p=0.01). There was no significant association between telemedicine use and hospitalizations. CONCLUSIONS The use of telemedicine to care for patients receiving in-center hemodialysis was associated with a slightly higher frequency of four-or-more visits per month but not with hospitalizations; the association with visit frequency was more pronounced in areas where providers had to travel longer distances to see patients in-person.