Original Research

Bridging the Digital Divide in Teledermatology Usage: A Retrospective Review of Patient Visits

Cutis. 2023 March;111(3):160-163,E2 | doi:10.12788/cutis.0722

References

Lee JJ, English JC. Teledermatology: a review and update. Am J Clin Dermatol. 2018;19:253-260.
Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: how COVID-19’s telemedicine expansion could exacerbate disparities. J Am Acad Dermatol. 2020;83:E345-E346.
Kennedy J, Arey S, Hopkins Z, et al. dermatologist perceptions of teledermatology implementation and future use after COVID-19: demographics, barriers, and insights. JAMA Dermatol. 2021;157:595-597.
Centers for Disease Control and Prevention. Using telehealth to expand access to essential health services during the COVID-19 pandemic. Updated June 10, 2020. Accessed February 10, 2023. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
United States Census Bureau. QuickFacts: Allegheny County, Pennsylvania. Accessed August 12, 2021. https://www.census.gov/quickfacts/alleghenycountypennsylvania
Moore HW. Teledermatology—access to specialized care via a different model. Dermatology Advisor. November 12, 2019. Accessed February 10, 2023. https://www.dermatologyadvisor.com/home/topics/practice-management/teledermatology-access-to-specialized-care-via-a-different-model/
Tripathi R, Knusel KD, Ezaldein HH, et al. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154:1286-1291.
Nouri S, Khoong EC, Lyles CR, et al. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic [published online May 4, 2020]. NEJM Catal Innov Care Deliv. doi:10.1056/CAT.20.0123
Swenson K, Ghertner R. People in low-income households have less access to internet services—2019 update. Office of the Assistant Secretary for Planning and Evaluation; US Department of Health and Human Services. March 2021. Accessed February 10, 2023. https://aspe.hhs.gov/sites/default/files/private/pdf/263601/internet-access-among-low-income-2019.pdf
Centers for Medicare and Medicaid Services. COVID-19 frequently asked questions (FAQs) on Medicare fee-for-service (FFS) billing. Updated August 16, 2022. Accessed February 10, 2023. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
US Department of Health and Human Services. Renewal of determination that a public health emergency exists. Updated February 9, 2023. Accessed February 20, 2023. https://aspr.hhs.gov/legal/PHE/Pages/COVID19-9Feb2023.aspx?
Augenstein J, Smith JM. Executive summary: tracking telehealth changes state-by-state in response to COVID-19. Updated January 27, 2023. Accessed February 10, 2023. https://www.manatt.com/insights/newsletters/covid-19-update/executive-summary-tracking-telehealth-changes-stat
Center for Connected Health Policy. Policy trend maps: store and forward Medicaid reimbursement. Accessed June 23, 2022. https://www.cchpca.org/policy-trends/

Teledermatology visits were used most frequently for acne and dermatitis, while IVs were used for skin cancer screenings and examination of concerning lesions. This usage pattern is consistent with a previously described consensus among dermatologists on the conditions most amenable to teledermatology evaluation.³

Medicaid reimbursement parity for SVs is in effect nationally until the end of the COVID-19 public health emergency declaration in the United States.¹⁰ As of February 2023, the public health emergency declaration has been renewed 12 times since January 2020, with the most recent renewal on January 11, 2023.¹¹ As of January 2023, 21 states have enacted legislation providing permanent reimbursement parity for SV services. Six additional states have some payment parity in place, each with its own qualifying criteria, and 23 states have no payment parity.¹² Only 25 Medicaid programs currently provide reimbursement for AV services.¹³

Study Limitations—Our study was limited by lack of data on patients who are multiracial and those who identify as nonbinary and transgender. Because of the low numbers of Hispanic patients associated with each race category and a high number of patients who did not report an ethnicity or race, race and ethnicity data were analyzed separately. For SVs, patients were instructed to upload photographs prior to their visit; however, the percentage of patients who uploaded photographs was not analyzed.

Conclusion

Expansion of teledermatology services, including SVs and AVs, patient outreach and education, advocacy for broadband access, and Medicaid payment parity, may improve dermatologic care access for medically marginalized groups. Teledermatology has the potential to serve as an effective health care option for patients who are racially minoritized, older, and underinsured. To further assess the effectiveness of teledermatology, we plan to analyze the number of SVs and AVs that were referred to IVs. Future studies also will investigate the impact of implementing patient education and patient-reported outcomes of teledermatology visits.

References

Lee JJ, English JC. Teledermatology: a review and update. Am J Clin Dermatol. 2018;19:253-260.
Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: how COVID-19’s telemedicine expansion could exacerbate disparities. J Am Acad Dermatol. 2020;83:E345-E346.
Kennedy J, Arey S, Hopkins Z, et al. dermatologist perceptions of teledermatology implementation and future use after COVID-19: demographics, barriers, and insights. JAMA Dermatol. 2021;157:595-597.
Centers for Disease Control and Prevention. Using telehealth to expand access to essential health services during the COVID-19 pandemic. Updated June 10, 2020. Accessed February 10, 2023. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
United States Census Bureau. QuickFacts: Allegheny County, Pennsylvania. Accessed August 12, 2021. https://www.census.gov/quickfacts/alleghenycountypennsylvania
Moore HW. Teledermatology—access to specialized care via a different model. Dermatology Advisor. November 12, 2019. Accessed February 10, 2023. https://www.dermatologyadvisor.com/home/topics/practice-management/teledermatology-access-to-specialized-care-via-a-different-model/
Tripathi R, Knusel KD, Ezaldein HH, et al. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol. 2018;154:1286-1291.
Nouri S, Khoong EC, Lyles CR, et al. Addressing equity in telemedicine for chronic disease management during the COVID-19 pandemic [published online May 4, 2020]. NEJM Catal Innov Care Deliv. doi:10.1056/CAT.20.0123
Swenson K, Ghertner R. People in low-income households have less access to internet services—2019 update. Office of the Assistant Secretary for Planning and Evaluation; US Department of Health and Human Services. March 2021. Accessed February 10, 2023. https://aspe.hhs.gov/sites/default/files/private/pdf/263601/internet-access-among-low-income-2019.pdf
Centers for Medicare and Medicaid Services. COVID-19 frequently asked questions (FAQs) on Medicare fee-for-service (FFS) billing. Updated August 16, 2022. Accessed February 10, 2023. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf
US Department of Health and Human Services. Renewal of determination that a public health emergency exists. Updated February 9, 2023. Accessed February 20, 2023. https://aspr.hhs.gov/legal/PHE/Pages/COVID19-9Feb2023.aspx?
Augenstein J, Smith JM. Executive summary: tracking telehealth changes state-by-state in response to COVID-19. Updated January 27, 2023. Accessed February 10, 2023. https://www.manatt.com/insights/newsletters/covid-19-update/executive-summary-tracking-telehealth-changes-stat
Center for Connected Health Policy. Policy trend maps: store and forward Medicaid reimbursement. Accessed June 23, 2022. https://www.cchpca.org/policy-trends/

Bridging the Digital Divide in Teledermatology Usage: A Retrospective Review of Patient Visits

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