A Focused Look at Audio Only & FQHCs

With a grant from the Federation of State Medical Board Foundation (FSMB Foundation), the Center for Connected Health Policy (CCHP) conducted a small study on the use of audio-only to treat Medicaid patients in a federally qualified health center (FQHC).  CCHP selected states to study that at the time the research was being conducted, had the highest number of COVID-19 cases per 100,000 people per the Centers for Disease Control and Prevention (CDC). CCHP examined each state’s pre-pandemic Medicaid fee-for-service policies, what was allowed during COVID-19, and the audio-only policies that were made permanent related to FQHCs.
The study re-confirmed what many would expect to have found in that audio-only provided another avenue for FQHCs to serve their patients who otherwise may have delayed or foregone care. There were also common themes found for using audio-only such as lack of robust connectivity for a live video visit, lack of equipment on the patient end, and preference by the patient for audio-only over live video. The most common services provided via audio-only included treatment for behavioral health and chronic conditions.
Some additional unique findings included FQHCs using audio-only if live video or in-person was not available or if the patient expressed a preference for it over other available delivery modes. At least for the FQHCs involved in these studies, this runs counter to some policymakers’ concerns that audio-only would be the first choice of providers to use. Another more unique finding is that entering into the pandemic, FQHCs that had a mature telehealth program still may not have been fully ready to provide services via telehealth as policies, depending on the jurisdiction, had those clinics only operating as originating site providers. During the pandemic, FQHCs were allowed to act as distant site providers, but may not have necessarily had that experience given the policies they may have had to operate under pre-pandemic. This means that FQHCs may have had more difficulties transitioning to telehealth at the beginning of COVID-19 despite previous experience.
The FQHCs in this study all expressed concerns for their patients’ ability to access care should the audio-only waivers not be made permanent or extended. At the time the research took place, Spring of 2021, none of the states examined had made any audio-only policies permanent.
CCHP researchers acknowledge the limitation of the study which had a small sample size and similarities amongst the states examined in population and geography. However, the states examined were rural states which does raise the concern that if audio-only policies are rolled back, there is a distinct possibility that rural populations will be put at an additional disadvantage to accessing health services.
  The full report can be accessed on CCHP’s website. CCHP wishes to thank the FSMB Foundation for their support in this research.