Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.
Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine.
J Rural Health. 2021 Sep;37(4):769-779. doi: 10.1111/jrh.12527. Epub 2020 Oct 21.
This study assesses trends in telehealth use in Maine-a rural state with comprehensive telehealth policies-across payers, services, and rurality, and identifies barriers and facilitators to the adoption and use of telehealth services.
Using a mixed-methods approach, researchers analyzed data from Maine's All Payer Claims Database (2008-2016) and key informant interviews with health care organization leaders to examine telehealth use and explore factors impacting telehealth adoption and implementation.
Despite a 14-fold increase in the use of telehealth over the 9-year study period, use remains low-0.28% of individuals used telehealth services in 2016 compared with 0.02% in 2008. Services provided via telehealth varied by rurality; speech language pathology (SLP) was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for over 70% of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. Issues challenging organizations seeking to deploy telehealth included provider resistance, staff turnover, provider shortages, and lack of broadband. Key informants identified inadequate and inconsistent reimbursement as barriers to comprehensive, systematic billing for telehealth services, resulting in underrepresentation of telehealth services in claims data.
Claims covered by Medicaid account for much of the observed expansion of telehealth use in Maine. Telehealth appears to be improving access to behavioral health and SLP services. Provider shortages, broadband, and Medicare and commercial coverage policies limit the use of telehealth services in rural areas.
本研究评估了缅因州（一个拥有全面远程医疗政策的农村州）在支付方、服务和农村地区的远程医疗使用趋势，并确定了采用和使用远程医疗服务的障碍和促进因素。
研究人员采用混合方法，分析了缅因州所有支付者索赔数据库（2008-2016 年）的数据和与医疗保健组织领导人的关键知情人访谈，以检查远程医疗的使用情况，并探讨影响远程医疗采用和实施的因素。
尽管在 9 年的研究期间远程医疗的使用增加了 14 倍，但使用率仍然很低-2016 年有 0.28%的人使用远程医疗服务，而 2008 年为 0.02%。通过远程医疗提供的服务因农村地区而异；言语病理（SLP）是农村居民最常见的服务类型，而精神科服务在城市居民中最为常见。在该州的农村和城市地区，医疗补助计划（Medicaid）是超过 70%的远程医疗索赔的主要支付方，这推动了远程医疗索赔的增长。组织在部署远程医疗方面面临的挑战包括提供者的抵制、员工流失、提供者短缺和缺乏宽带。关键知情人确定，报销不足和不一致是全面、系统计费远程医疗服务的障碍，导致索赔数据中远程医疗服务的代表性不足。
医疗补助计划涵盖的索赔占缅因州观察到的远程医疗使用扩张的大部分。远程医疗似乎改善了获得行为健康和 SLP 服务的机会。提供者短缺、宽带以及医疗保险和商业保险政策限制了农村地区远程医疗服务的使用。
