Objective: Telemedicine has developed as an innovative way to remotely view and treat patients without necessitating for patients to physically come into a physicians’ office or healthcare facility. This study aims to provide insights into the effectiveness of integrating telemedicine in medical facilities, where patients have high hierarchical condition category (HCC) risk scores. Design: This study utilized two raw datasets: (1) a Centers for Medicare & Medicaid Services (CMS) dataset created from the 2017 Medicare Physician and Other Supplier National Provider Identity Aggregate Report and (2) a National Center for Education Statistics (NCES) dataset created from the NCES table on the number and percentage of households in each state with computer and internet access. A regression analysis was carried out on the CMS dataset to determine the correlation between HCC risk scores and the reimbursement lost by healthcare facilities, where over 50% of their patients are diagnosed with chronic obstructive pulmonary disease (COPD). A second analysis was conducted with the NCES dataset to show which states had a high proportion of both households with internet access and COPD patients. A final regression analysis was run and translated into an interactive map in order to determine which regions of the United States could most benefit from telemedicine adoption. Results: This study discovered a number of physicians and healthcare facilities in the eastern region of the United States that could benefit significantly from telemedicine applications. These findings were supported by the locations and data abstracted from facilities with high numbers of COPD patients, which were found to have poor HCC risk scores and thus high reimbursement losses. Conclusions: This study confirmed the association between HCC risk scores and reimbursement losses. In order to alleviate those losses, this study identified states across the United States that should choose to incorporate telemedicine into how they diagnose and treat patients based on the needs of healthcare facilities and the internet capabilities of households in those states, because telemedicine integration presents the potential to improve patient HCC risk scores and reimbursement amounts by lowering readmission rates while also promoting higher patient and physician satisfaction. Future efforts should develop specific strategies to assist with telemedicine implementation and should track the observed effects of its adoption on reimbursements and quality of care.
Yeatts J, Sangvai D. HCC coding, risk adjustment, physician income: What you need to know. Fam Pract Manag. 2016;24–7.
2.
Mehta HB, Dimou F, Adhikari D, Tamirisa NP, Sieloff E, Williams TP, et al. Comparison of Comorbidity Scores in Predicting Surgical Outcomes. Medical Care. 2016;54(2):180–7.
3.
Nih. NIH statement on World COPD Day. 2018;
4.
Omachi TA, Gregorich SE, Eisner MD, Penaloza RA, Tolstykh IV, Yelin EH, et al. Risk Adjustment for Health Care Financing in Chronic Disease. Medical Care. 2013;51(8):740–7.
5.
Portillo E, Wilcox A, Seckel E. Reducing COPD readmission rates: Using a COPD care service during care transitions. Fed Pract. 2018;(11):30–6.
6.
Turcotte J, Sanford Z, Broda A, Patton C. Centers for Medicare & Medicaid Services Hierarchical Condition Category score as a predictor of readmission and reoperation following elective inpatient spine surgery. Journal of Neurosurgery: Spine. 2019;31(4):600–6.
7.
Health Catalyst Editors. Five action items to improve HCC coding accuracy and risk adjustment with analytics. Health Catalyst. 2019;
8.
Akinleye DD, McNutt LA, Lazariu V, McLaughlin CC. Correlation between hospital finances and quality and safety of patient care. PLOS ONE. 2019;14(8):e0219124.
9.
Bazzoli GJ, Clement JP, Lindrooth RC, Chen HF, Aydede SK, Braun BI, et al. Hospital Financial Condition and Operational Decisions Related to the Quality of Hospital Care. Medical Care Research and Review. 2007;64(2):148–68.
10.
Encinosa WE, Bernard DM. Hospital Finances and Patient Safety Outcomes. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2005;42(1):60–72.
11.
Dong GN. Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease. BMC Health Services Research. 2015;15(1).
12.
Smith RB, Dynan L, Fairbrother G, Chabi G, Simpson L. Medicaid, Hospital Financial Stress, and the Incidence of Adverse Medical Events for Children. Health Services Research. 2012;47(4):1621–41.
13.
Prakash B. Patient satisfaction. Journal of Cutaneous and Aesthetic Surgery. 2010;3(3):151.
14.
Wicklund E. Using telemedicine to boost HEDIS, reduce risk and fight blindness. 2016;
15.
Baggot D, Glick S, Lapsley H, Garg P, Javanmardian M, Macphearson M. Telehealth’s opportunities in new Medicare advantage rule. Oliver Wymman. 2019;
16.
O’Connor M, Dempsey M, Huffenberger A, Jost S, Flynn D, Norris A, et al. Using Telehealth to Reduce All-Cause 30-Day Hospital Readmissions among Heart Failure Patients Receiving Skilled Home Health Services. Applied Clinical Informatics. 2016;07(02):238–47.
17.
Ronda MC, Dijkhorst-Oei LT, Rutten GE. Reasons and Barriers for Using a Patient Portal: Survey Among Patients With Diabetes Mellitus. Journal of Medical Internet Research. 2014;16(11):e263.
18.
Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare. 2016;24(1):4–12.
19.
Cms. Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year. 2017;
20.
Holm KE, Plaufcan MR, Ford DW, Sandhaus RA, Strand M, Strange C, et al. The impact of age on outcomes in chronic obstructive pulmonary disease differs by relationship status. Journal of Behavioral Medicine. 2013;37(4):654–63.
Citation
Copyright
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.