title: Medicare payments, healthcare service use, and telemedicine implementation costs in a randomized trial comparing telemedicine case management with usual care in medically underserved participants with diabetes mellitus (IDEATel).
abstract: Objective To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention. Design We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State. Measurements We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006). Results Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month. Conclusion Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.
authors.affiliation: Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA. wp56@columbia.edu
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Justin
authors.initials: J
authors.lastname: Starren
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ganz
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Burton
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
authors.forename: Jan
authors.initials: J
authors.lastname: Blustein
authors.forename: Lesley
authors.initials: L
authors.lastname: Field
authors.forename: Philip C
authors.initials: PC
authors.lastname: Morin
authors.forename: Roberto E
authors.initials: RE
authors.lastname: Izquierdo
authors.forename: Stephanie
authors.initials: S
authors.lastname: Silver
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Lantigua
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
mesh_terms: D000368:Aged; D019090:Case Management / Q000191:economics*; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006284:Health Plan Implementation / Q000191:economics; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009518:New York; D017216:Telemedicine / Q000191:economics*; D014481:United States