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Association Between Broadband Internet Availability and Telemedicine Use

2019; American Medical Association; Volume: 179; Issue: 11 Linguagem: Inglês

10.1001/jamainternmed.2019.2234

2168-6114

Andrew D. Wilcock, Sherri Rose, Alisa B. Busch, Haiden A. Huskamp, Lori Uscher‐Pines, Bruce E. Landon, Ateev Mehrotra,

Healthcare Systems and Technology

Association Between Broadband Internet Availability and Telemedicine UseAccess to health specialists is difficult for many individuals in rural communities. 1Telemedicine, health care service delivered remotely through telecommunications, is one potential solution, but its use varies across regions, potentially associated with the availability of high-speed internet (broadband) access. 2 The Federal Communications Commission (FCC) and Congress have emphasized the need to increase broadband access in rural communities, in part to facilitate the use of telemedicine, and the FCC's Connect America Fund has set aside billions of dollars to subsidize broadband expansion. 3Our objective was to examine whether broadband availability in local communities is associated with telemedicine use.Methods | This study was approved by the Harvard Medical School Institutional Review Board, which waived the requirement for informed patient consent because of deidentified data.Per capita rates of telemedicine visits for each US county in 2016 were calculated using a nationally representative 20% sample of Medicare fee-for-service beneficiaries and data from Op-tumLabs Data Warehouse, a deidentified claims database for privately insured enrollees and Medicare Advantage enrollees in a large, private US health plan.Telemedicine visits were defined as health professional claims with either a telemedicine modifier (GT, GQ, 95) or a telemedicine-specific code (G0425-7, G0406-8, or G0459).Counts of visits were based on the beneficiary's county of residence.Because Medicare does not cover telemedicine for nonrural beneficiaries living in metropolitan counties, we did not include these beneficiaries in our per capita rates.We removed counties without rural residents, without both commercial and Medicare beneficiaries, and outlier counties in the top percentile of per capita telemedicine use.We measured broadband availability at the county level using the FCC's Fixed Broadband Deployment Data. 4 Broadband access was defined as the availability of wired internet download speeds of at least 25 megabytes per second and upload speeds of at least 3 megabytes per second. 5Counties were categorized based on the share of the county's population that could purchase broadband: low availability (0%-40%), medium availability (>40%-70%), or high availability (>70%).In each county, we also determined the number of census blocks targeted by the FCC's Connect America Fund.