Telehealth use varies by specialty, patient demographics, two new studies show
Telehealth usage has surged amid the Covid-19 pandemic, but its use varies greatly in accordance with clinical and patient demographic factors, according to a pair of new studies.
As Covid-19 cases spiked in 2020, there was a concurrent shift in care delivery. Hospitals and health systems pivoted to telehealth to care for scores of patients while reducing the need for them to come into healthcare facilities overrun by Covid-19 patients.
During the pandemic, 30.1% of all visits were provided via telemedicine, and the weekly number of visits increased 23-fold compared with the pre-pandemic period, a study published in Health Affairs shows.
For the study, researchers examined data for 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020.
They found there was wide variation in telehealth use by specialty, ranging from 68% of endocrinologists to 9% of ophthalmologists.
Further, there was a huge difference in the specific conditions that telehealth was used to treat. The percentage of visits provided during the pandemic via telemedicine ranged from 53% for depression to 3% for glaucoma.
The second study, which was published in the Journal of the American Medical Association, focused on telehealth use among the low-income population in California.
The study included data for 534 federally qualified health centers. Researchers compared the number of primary care and behavioral health visits during the March-August 2020 pandemic period to the February 2019-February 2020 pre-pandemic period.
During the pre-pandemic period, there were an average of 231.7 primary care visits per 1,000 patients per month compared with 228.6 visits per 1,000 patients per month during the Covid-19 pandemic period. There was no significant change in the number of behavioral health visits.
The study’s key finding was that most of the telehealth appointments during the pandemic period were conducted over the phone.
There were 111 telephone appointments conducted per 1,000 patients per month for primary care, which represented 48.5% of visits. In contrast, there were 7.8 video visits conducted per 1,000 patients per month, which amounted to about 3.4% of primary care visits.
Similarly, for behavioral health, 18.2 telehealth visits per 1,000 patients per month were conducted via telephone, which is about 63.3% of visits. There were only 4 video visits conducted per 1,000 patients per month for behavioral health, which represents 13.9% of visits.
Audio-only visits may have been higher “because low-income patients face unique barriers to accessing video visits, and federally qualified health centers lack resources to develop the necessary infrastructure,” the study authors wrote.
Telehealth visits delivered via telephone peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits, according to the study.
Before the pandemic, many definitions of telehealth excluded telephone-only visits, and they were rarely reimbursed by private insurers or the government, the study authors wrote. Some payers, including the Centers for Medicare and Medicaid Services, have indicated they may stop reimbursing for audio-only visits when the pandemic ends.
“While there are important concerns about the quality of audio-only visits, eliminating coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of clinics to meet patient needs,” said Lori Uscher-Pines, lead author of the study and a senior policy researcher at nonprofit RAND.
Photo: Anastasia Usenko, Getty Images