Office Visits Rebound; CMS Expands Telehealth Services; Virtual Care for Chronic Pain
Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.
Outpatient Visits Rebound
Outpatient visits per week have rebounded to pre-pandemic levels, but not for all providers and patients, a new Commonwealth Fund report showed.
In total, weekly outpatient visit counts have slightly exceeded pre-pandemic levels, but varied by patient age, geographic area, clinical specialty, and insurance coverage, the research institute reported.
Weekly visits to dermatologists, urologists, and adult primary care physicians, for example, were higher than before the pandemic, while visits to pulmonologists and behavioral health providers were considerably lower.
As in-person visits dropped during the early days of the COVID-19 public health emergency, telemedicine visits rose rapidly. Since peaking in mid-April, telemedicine use has steadily declined, but has remained above pre-pandemic levels.
“The most recent data — the week of October 4 — show striking variation among medical specialties in the percentage of visits that are conducted via telemedicine,” wrote Ateev Mehrotra, MD, MPH, of Harvard Medical School in Boston, and colleagues. “Telemedicine use in many surgical specialties is very low, but in other specialties, especially behavioral health, its use remains robust.”
Across outpatient providers, telemedicine use varied: about one-third never adopted telemedicine at all. From April to September, many shifted from heavy or moderate to minimal telemedicine use.
The analysis was based on data from more than 50,000 outpatient providers that are clients of the healthcare technology company Phreesia and was conducted by the Commonwealth Fund, Phreesia, and Harvard University researchers. Providers included independent single-provider practices, multi-specialty groups, federally qualified health centers, and large health systems. Visits were captured from Feb. 1 through Oct. 10, 2020.
CMS Expands Telehealth Services
The Centers for Medicare & Medicaid Services (CMS) added 11 new telehealth services Medicare will reimburse during the COVID-19 public health emergency, including cardiac and pulmonary rehab, the agency announced on October 14. Medicare will start paying eligible practitioners who offer these services effective immediately.
In addition, CMS is providing extra support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies to expand telehealth access. “Medicaid patients should not be forgotten, and today’s announcement promotes telehealth for them as well,” CMS Administrator Seema Verma said.
The 11 new services mean Medicare will pay for a total of 144 telehealth services during the COVID-19 public health emergency. The emergency, which was set to expire later this month, was renewed for an additional 90 days on October 2.
The expansion builds on steps CMS already has taken to increase telehealth access during COVID-19, the agency noted. In May, CMS modified its processes to allow telehealth services to be added or deleted more quickly during the pandemic.
CMS also released an early peek at Medicaid and CHIP telehealth use during COVID-19. The snapshot showed more than 34.5 million services were delivered to Medicaid and CHIP beneficiaries by telehealth between March and June 2020, an increase of more than 2,600% compared with the same period in the previous year.
Adults, ages 19 to 64 years, received the most Medicaid telehealth services, but there was substantial variance across age groups and states. Overall, Medicaid telehealth rates peaked in April and began to fall in May.
Virtual Pain Care Gets High Marks
Even before the COVID-19 pandemic, chronic pain patients were highly satisfied with telemedicine, according to research presented at the 2020 American Society of Anesthesiologists annual meeting.
In 2019, researchers at the University of California Los Angeles (UCLA) Comprehensive Pain Center, began giving patients the option of either in-office appointments or telehealth visits through an audio-visual platform or by phone. Nearly 1,400 patients chose telehealth, resulting in about 2,950 virtual appointments in a 7-month period, reported mHealth Intelligence.
Patients who opted for virtual visits saved a median of 69 minutes in traffic per trip and $22 on gas and parking per visit. Of 327 patients who completed surveys, 92% said they were satisfied with their telehealth experience.
The findings add to growing evidence that connected technology can help people with chronic pain, either through devices that track and transmit data from patients to caregivers or through virtual visits, mHealth Intelligence noted.
“Patients who are being evaluated for new conditions may be better off having office visits initially,” lead author Laleh Jalilian, MD, of Ronald Reagan UCLA Medical Center in Los Angeles, said in statement. “But once patients establish a relationship with providers, follow-up visits can occur efficiently with telemedicine, while maintaining patient rapport and quality outcomes.”
“We believe 50% of our visits could be conducted via telemedicine,” she added. “Now that telemedicine is more widespread, it may become a valued part of care delivery in chronic pain practices.”