Availability of Telehealth Services for Total Knee Arthroplasty at Orthopaedic Surgery Practices

Background: For patients in lower socioeconomic groups who are unable to take time off from work, afford transportation to a clinic, or who live in rural locations, telehealth appointments have been found to improve access to care. Given how knee osteoarthritis disproportionately impacts patients in lower socioeconomic groups, we sought to evaluate the availability of telehealth appointments in orthopaedic surgery practices for patients with knee osteoarthritis with private or public (Medicaid) insurance. Methods: A secret shopper methodology was utilized for a scenario designed to measure access to telehealth appointments for patients with knee osteoarthritis. The caller asked questions regarding the availability and wait times for telehealth and in-person appointments for both new visits and follow-up visits. Separate calls were made for private and public insurance. Descriptive characteristics and univariate tests were used for analysis. Results: For initial new patient consults, 4.3% (13/304) of practices accepting private insurance offered telehealth and 3.6% (7/196) of practices accepting Medicaid offered telehealth. For follow-up visits, 39.8% (121/304) of practices accepting private insurance offered telehealth, and 40.3% (79/196) of practices accepting Medicaid offered telehealth. No differences were found in the availability of telehealth services for patients with Medicaid compared to patients with private insurance. Discussion: Telehealth is an underutilized but viable option for patients who are considering knee arthroplasty, especially for follow-up appointments. Implementing telehealth follow-up appointments can be beneficial to patients and surgeons. Further research should examine the barriers that limit the availability of telehealth in arthroplasty clinics and how a lack of musculoskeletal telehealth services, especially for patients of lower socioeconomic status, may affect access to osteoarthritis care.