Financial Performance of Hospital Telehealth Adopters, Nonadopters, and Switchers: A Rural-Urban Comparison
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 adopti...
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| Vydáno v: | Journal of healthcare management Ročník 70; číslo 2; s. 93 - 107 |
|---|---|
| Hlavní autoři: | , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
Wolters Kluwer Health, Inc
01.03.2025
Lippincott Williams & Wilkins Ovid Technologies |
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| ISSN: | 1096-9012, 1944-7396 |
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| 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. |
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| AbstractList | 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. 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. 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.GOALSThe 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.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.METHODSThis 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.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.PRINCIPAL FINDINGSThe 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.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.PRACTICAL APPLICATIONSThe 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. 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. 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. 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. 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. |
| Author | Tilford, J. Mick Karim, Saleema A. Hayes, Corey J. Bogulski, Cari A. Eswaran, Hari |
| Author_xml | – sequence: 1 givenname: Saleema A. surname: Karim fullname: Karim, Saleema A. organization: Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia – sequence: 2 givenname: Cari A. surname: Bogulski fullname: Bogulski, Cari A. organization: Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Northwest Campus, Fayetteville, Arkansas – sequence: 3 givenname: J. Mick surname: Tilford fullname: Tilford, J. Mick organization: Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas – sequence: 4 givenname: Corey J. surname: Hayes fullname: Hayes, Corey J. organization: Departments of Biomedical Informatics, Psychiatry, and Pharmacy Practice, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas – sequence: 5 givenname: Hari surname: Eswaran fullname: Eswaran, Hari organization: Department of Obstetrics and Gynecology, Institute for Digital Health & Innovation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40059202$$D View this record in MEDLINE/PubMed |
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| Notes | For more information, contact Dr. Karim at karims2@vcu.edu. The authors declare no conflicts of interest. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
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| References_xml | – volume: 37 start-page: 801 issue: 4 year: 2021 end-page: 811 ident: R8 article-title: Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas publication-title: The Journal of Rural Health – volume: 28 start-page: 781 issue: 6 year: 2022 end-page: 788 ident: R3 article-title: Association of financial factors and telemedicine adoption for heart attack and stroke care among rural and urban hospitals: A longitudinal study publication-title: Telemedicine and E-Health – volume: 37 start-page: 1967 issue: 12 year: 2018 end-page: 1974 ident: R17 article-title: Telehealth in health centers: Key adoption factors, barriers, and opportunities publication-title: Health Affairs – volume: 5 start-page: 166 issue: 2 year: 2016 end-page: 188 ident: R6 article-title: Exploring technology adoption in the case of the patient-centered medical home publication-title: Health Policy and Technology – volume: 35 start-page: 1665 issue: 9 year: 2016 end-page: 1672 ident: R16 article-title: Medicaid expansion affects rural and urban hospitals differently publication-title: Health Affairs – volume: 29 start-page: 540 issue: 7 year: 2023 end-page: 551 ident: R5 article-title: A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion publication-title: Journal of Telemedicine and Telecare – volume: 27 start-page: 2411 issue: 9 year: 2018 end-page: 2417 ident: R22 article-title: Telestroke adoption among community hospitals in North Carolina: A cross-sectional study publication-title: Journal of Stroke & Cerebrovascular Diseases – reference: American Hospital Association. 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start-page: 540 issue: 7 year: 2023 ident: R5-20250310 article-title: A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion publication-title: Journal of Telemedicine and Telecare doi: 10.1177/1357633X21998201 – volume: 7 start-page: 1 issue: 9 year: 2023 ident: R15-20250310 article-title: Financial performance of rural hospitals persistently lacking or having telehealth technology publication-title: Journal of Hospital Management and Health Policy – volume: 1 issue: 2 year: 2020 ident: R18-20250310 article-title: Rapidly converting to “virtual practices”: Outpatient care in the era of Covid-19 publication-title: NEJM Catalyst Innovations in Care Delivery – volume: 27 start-page: 2411 issue: 9 year: 2018 ident: R22-20250310 article-title: Telestroke adoption among community hospitals in North Carolina: A cross-sectional study publication-title: Journal of Stroke & Cerebrovascular Diseases doi: 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| SubjectTerms | Health care policy Hospitals Hospitals, Rural - economics Hospitals, Rural - statistics & numerical data Hospitals, Urban - economics Hospitals, Urban - statistics & numerical data Humans Longitudinal studies Medicare Profitability Retrospective Studies Rural areas Rural health care Technology adoption Telemedicine Telemedicine - economics Telemedicine - statistics & numerical data United States Urban health care Variables |
| Title | Financial Performance of Hospital Telehealth Adopters, Nonadopters, and Switchers: A Rural-Urban Comparison |
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