Financial Performance of Hospital Telehealth Adopters, Nonadopters, and Switchers: A Rural-Urban Comparison.

IF 1.7 4区 医学 Q3 HEALTH POLICY & SERVICES
Journal of Healthcare Management Pub Date : 2025-03-01 Epub Date: 2025-03-06 DOI:10.1097/JHM-D-24-00026
Saleema A Karim, Cari A Bogulski, J Mick Tilford, Corey J Hayes, Hari Eswaran
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引用次数: 0

Abstract

Goals: The adoption of telehealth in healthcare delivery has transformed patient treatment options. Urban and rural hospitals are increasingly using telehealth to reach more patients, improve patient engagement, and increase healthcare quality. Hospitals experience the operational benefits of adopting telehealth through improving clinical workflow, increasing efficiency, and improving patient satisfaction. These benefits may have financial implications through increases in patient volume and revenue, and reductions in provider overhead and costs. The overall effect of telehealth adoption on hospital financial performance is currently unknown. This study examines the association of telehealth adoption with the financial performance of rural and urban hospitals.

Methods: This study uses retrospective data to examine the differences between urban and rural hospitals and community characteristics, profitability, and telehealth adoption from 2009 to 2019 in the United States. Data were obtained from the American Hospital Association Annual Survey and the Information Technology Supplement, the Centers for Medicare & Medicaid Services Healthcare Cost Report Information Systems, and the Area Health Resource File. Telehealth adoption status was determined using the American Hospital Association Annual Survey and the Information Technology Supplement Survey. Hospitals were classified into three categories, according to telehealth adoption status: (1) telehealth persistent nonadopters, (2) telehealth persistent adopters, and (3) telehealth switchers. Hospital financial performance was measured using operating margin and total margin. Descriptive statistics were used to evaluate the variation between the three categories of telehealth adoption status and hospital characteristics, hospital financial performance, and community characteristics.

Principal findings: The study sample of 1,530 hospitals consisted of 56% rural hospitals and 44% urban hospitals. The results reveal disparities in financial performance between rural and urban hospitals. From 2009 to 2019, both rural and urban hospitals, identified as telehealth persistent adopters, exhibited higher operating and total margins compared to telehealth persistent nonadopter hospitals. Hospitals that transitioned from telehealth nonadopters to telehealth adopters, started with operating and total margins that closely aligned with telehealth persistent nonadopters. However, as hospitals adopted telehealth, both operating and total margins followed closely to telehealth persistent adopters. The results indicate that while hospital financial performance is associated with telehealth adoption, inferring causation is beyond the scope of these results.

Practical applications: The telehealth adoption status has unveiled noticeable patterns in hospital financial performance. In both rural and urban settings, hospitals persistently lacking telehealth capacity have the worst financial performance when compared to hospitals that persistently maintained telehealth services or hospitals that adopted telehealth over the study period. Overall, urban hospitals had better financial performance, which is likely associated with higher caseloads and payer mix compared to rural hospitals. Hospitals that adopted telehealth over the study period showed an increase in financial margins similar to hospitals with persistent telehealth adoption. Targeted policies that address the specific financial challenges of hospitals with a history of poor performance could effectively increase telehealth adoption in these settings. Future research should examine whether adoption among hospitals persistently lacking telehealth can influence the quality and accessibility of services, along with associated health outcomes to determine whether more aggressive policy action is warranted.

医院远程医疗采用者、非采用者和转换者的财务绩效:一项城乡比较。
目标:在医疗保健服务中采用远程医疗改变了患者的治疗选择。城市和农村医院越来越多地使用远程医疗服务,以接触更多的患者,提高患者参与度,并提高医疗保健质量。通过改进临床工作流程、提高效率和提高患者满意度,医院体验到了采用远程医疗的运营优势。这些好处可能会增加患者数量和收入,并减少提供者的管理费用和成本,从而产生财务影响。采用远程医疗对医院财务绩效的总体影响目前尚不清楚。本研究考察了远程医疗采用与农村和城市医院财务绩效的关系。方法:本研究采用回顾性数据分析2009年至2019年美国城乡医院、社区特征、盈利能力和远程医疗采用的差异。数据来自美国医院协会年度调查和信息技术补充,医疗保险和医疗补助服务中心医疗成本报告信息系统,以及地区卫生资源文件。采用美国医院协会年度调查和信息技术补充调查确定了远程医疗的采用状况。根据远程医疗采用状况,将医院分为三类:(1)远程医疗持续不采用者;(2)远程医疗持续采用者;(3)远程医疗转换者。医院的财务表现是用营业利润率和总利润率来衡量的。使用描述性统计来评估远程医疗采用状况与医院特征、医院财务绩效和社区特征这三类之间的差异。主要发现:研究样本为1,530家医院,其中农村医院占56%,城市医院占44%。结果揭示了农村医院和城市医院财务绩效的差异。从2009年到2019年,与长期未采用远程医疗的医院相比,被确定为远程医疗持续采用者的农村和城市医院的营业利润率和总利润率都更高。从不采用远程医疗向采用远程医疗过渡的医院,其运营和总利润率与长期不采用远程医疗的医院密切相关。然而,随着医院采用远程医疗,运营利润率和总利润率都与远程医疗的长期采用者密切相关。结果表明,虽然医院财务绩效与远程医疗采用有关,但推断因果关系超出了这些结果的范围。实际应用:远程医疗的采用状况揭示了医院财务绩效的显著模式。在农村和城市环境中,与持续提供远程医疗服务的医院或在研究期间采用远程医疗的医院相比,长期缺乏远程医疗能力的医院的财务表现最差。总体而言,城市医院的财务表现较好,这可能与农村医院的病例量和付款人组合较高有关。在研究期间采用远程医疗的医院,其财务利润率的增长与持续采用远程医疗的医院相似。针对业绩不佳的医院的具体财务挑战制定有针对性的政策,可以有效地增加这些环境中远程医疗的采用。未来的研究应检查在长期缺乏远程医疗的医院中采用远程医疗是否会影响服务的质量和可及性,以及相关的健康结果,以确定是否有必要采取更积极的政策行动。
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来源期刊
Journal of Healthcare Management
Journal of Healthcare Management HEALTH POLICY & SERVICES-
CiteScore
2.00
自引率
5.60%
发文量
68
期刊介绍: The Journal of Healthcare Management is the official journal of the American College of Healthcare Executives. Six times per year, JHM offers timely healthcare management articles that inform and guide executives, managers, educators, and researchers. JHM also contains regular columns written by experts and practitioners in the field that discuss management-related topics and industry trends. Each issue presents an interview with a leading executive.
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