Telehealth used in 30.1% of visits during COVID-19 pandemic

Telehealth visits accounted for approximately 30% of total outpatient visits early in the COVID-19 pandemic, with uptake varying among specialties and by patient characteristics, according to research published in Health Affairs.

“In response to the coronavirus disease 2019 (COVID-19) pandemic, telemedicine use grew dramatically within a matter of weeks,” Sadiq Y. Patel, PhD, National Institute of Mental Health postdoctoral research fellow in the department of health care policy at Harvard Medical School, and colleagues wrote. “After years of slow adoption, many clinicians used telemedicine for the first time to limit patient and staff exposure to the virus.”

Patel and colleagues assessed data from 16.7 million individuals with commercial or Medicare Advantage insurance to evaluate trends in telehealth and in-person visits from January 1, 2020, to June 16, 2020. They evaluated whether these visits varied based on patient characteristics, specialty or patients’ medical conditions.

The researchers collected declassified data on medical claims and insurance enrollment from the OptumLabs Data Warehouse and county-level characteristics from the U.S. census and publicly available data on COVID-19 cases per county.

Individuals who were continuously enrolled in a medical plan for 12 months from July 2019 and June 2020 were included in the study.

The researchers defined the pre-COVID-19 period as January 1, 2020, through March 17, 2020, and the COVID-19 period as March 18, 2020, through June 16, 2020. According to the researchers, March 18 was chosen as the start of the COVID-19 period because CMS announced the day before that it would expand telehealth services covered for the pandemic.

The final sample included 16,740,365 enrollees, 78.5% of whom were commercially insured and 87.7% of whom lived in urban communities.

Patel and colleagues found 30.1% of all visits were conducted via telehealth during the COVID-19 period.

Additionally, they determined that the weekly number of telehealth visits rose from 16,540 to 397,977 per week — a 23-fold increase — from the pre-COVID-19 period to the COVID-19 period.

Although there was an increase in telehealth visits, the overall visit volume dropped by 35% from the pre-COVID-19 period to the COVID-19 period.

Patel and colleagues determined that the percentage of total telehealth visits was smallest among adults aged 65 years and older at 23.7% compared with 38.7% among adults aged 30 to 39 years.

At 23.9%, the researchers found that rural counties had a lower proportion of telehealth visits during the COVID-19 period compared with 30.7% of visits in urban counties.

Among specialties, telehealth was used at least once by 67.7% of endocrinologists, 57% of gastroenterologists and 56.3% of neurologists. However, the use of telehealth was considerably lower among some specialties, with just 3.3% of optometrists, 6.6% of physical therapists, 9.3% of ophthalmologists and 20.7% of orthopedic surgeons using telehealth at least once during the pandemic.

“Consistent with concerns of the ‘digital divide’ in telemedicine access, we found lower telemedicine use in high-poverty counties during COVID-19, whereas changes in total visits were similar,” Patel and colleagues wrote.

They added that the “digital divide” was also observed in the use of telehealth in rural areas.

“One potential explanation for this finding is that limited broadband availability in rural areas is a barrier to telemedicine use,” Patel and colleagues wrote.