Trends in Remote Patient Monitoring Before and After the COVID-19 Public Health Emergency Declaration in the United States: A Comparison Between Rural/Urban and Racial/Ethnic Group.

Abstract

Background: This study assesses the trend in remote patient monitoring (RPM) utilization among Medicare beneficiaries in the United States with differing rural/urban and racial/ethnic statuses. Methods: Using Medicare fee-for-service claims from January 2018 to December 2020, monthly rates of beneficiaries utilizing RPM per 100,000 beneficiaries enrolled in both Medicare Parts A and B were calculated. Comparative interrupted time series models delineated differences in level and trend of RPM utilization between beneficiaries with differing rural/urban status, race/ethnicity, and race/ethnicity as stratified by rural/urban status using March 2020, the start of COVID-19 public health emergency (PHE) in the United States, as interruption time. Results: RPM utilization increased from 2 to 240 RPM claims per 100,000 Medicare beneficiaries from January 2018 to December 2020. Urban beneficiaries experienced a 24.20 RPM user-level change per month at the start of PHE. Trend difference for urban versus rural beneficiaries increased by 7.85 RPM users per month before and after the start of PHE (p < 0.0001). The trend difference for non-Hispanic Black versus White beneficiaries significantly increased by 12.43 RPM users per 100,000 beneficiaries per month after declaration of PHE (p < 0.0001). Similarly, the trend difference for beneficiaries of Hispanic and of other races significantly increased by 7.48 and 16.93 RPM users per 100,000 beneficiaries per month, respectively, after the declaration of the PHE (p < 0.0001 for both). Trends for racial/ethnic minorities stratified by rural/urban status were similar to the overall trends by racial/ethnic group. Discussion: Inequities in RPM utilization exist and were exacerbated by the COVID-19 pandemic. Targeted interventions are needed to increase RPM utilization broadly, particularly among rural residents.