Initial telehealth visits are associated with fewer in-person follow-up visits than initial office visits for most specialties, a new study shows.
The Epic Research study found that 16 out of 24 specialties had higher follow-up rates within 90 days of an initial office visit than a telehealth visit. This includes mental health, physical medicine and rehabilitation and pain medicine, which all had a more than 20% higher follow-up rate after an in-person office appointment than a telehealth appointment:
For mental health, just 9.53% of initial telehealth visits led to an in-person follow-up visit, while 40.28% of initial office visits led to a follow-up visit.
For physical medicine and rehabilitation, 20.52% of initial telehealth visits led to an in-person follow-up visit, and 44.55% of initial office visits led to an in-person follow-up visit.
For pain medicine, 22.24% of initial telehealth visits led to an in-person follow-up visit, while 42.79% of initial office visits led to an in-person follow-up visit.
Epic Research is a research organization made up of clinicians and data scientists that aims to share knowledge on medical and public health problems. The organization’s study analyzed 40.7 million specialty and 32.1 million primary care encounters between January 2022 and March 2023. The researchers excluded specialties that had fewer than 400,000 encounters during the time period. It follows two previous Epic Research studies that found most telehealth appointments don’t need an in-person follow-up visit within 90 days of the first appointment.
What do these findings suggest? That telehealth can “stand alone and can be a sufficient form of care for many patients,” said Jackie Gerhart, chief medical officer of Epic Research, in an email.
“It was previously thought that telehealth visits might be used as an ‘interim’ visit, meaning that not everything could be covered by telehealth so the person would also need an in-person visit for evaluation and management,” Gerhart said. “This study shows that for most specialties, people aren’t needing an in-person visit to follow-up after a telehealth visit.”
Not all specialties had lower follow-up rates for telehealth than office visits, however. This includes ophthalmology; obstetrics and gynecology; podiatry; ear, nose and throat; dermatology; allergy; pediatric and internal medicine. Ophthalmology, obstetrics and gynecology and podiatry all had an at least 9% higher in-person follow-up rate after telehealth appointments than office appointments:
For ophthalmology, 30.52% of initial telehealth visits led to an in-person follow-up visit, while 21.37% of initial office visits led to an in-person follow-up visit.
For obstetrics and gynecology, 31.22% of initial telehealth visits led to an in-person follow-up visit, while 22.01% of initial office visits led to an in-person follow-up visit.
For podiatry, 41.35% of initial telehealth visits led to an in-person follow-up visit, while 28.77% of initial office visits led to an in-person follow-up visit.
In addition, all types of primary care — family medicine, pediatric and internal medicine — had follow-up rates for telehealth and office visits within two percentage points of each other, meaning there wasn’t a significant difference between the two options. Pediatrics and internal medicine had slightly higher follow-up rates for telehealth, while family medicine had a slightly higher follow-up rate for office visits.
There are some shortcomings with the research, Gerhart noted.
“It’s possible that those using telehealth may have fewer or less complex concerns and therefore don’t need follow-up,” Gerhart stated. “Additionally, patients often self-select the way they would like to receive care; so, it may be that those who choose telehealth will prefer to have a follow-up telehealth visit, which we didn’t assess in this study. In future studies we will be looking at both the complexity of visits between telehealth and in-person care and the effect that insurance coverage has on telehealth utilization.”
How should different healthcare stakeholders respond to these findings? The government and policymakers should use them to “inform future regulatory and funding efforts that affect the adoption of telehealth services,” Gerhart said. For payers, these findings suggest that telehealth can be a sufficient way to provide care, something that should be considered when determining coverage. Health systems, meanwhile, should continue offering telehealth as it may be patients’ preferred way of receiving care, according to Gerhart.
MedCityNews | July 7, 2023