Contagious Disease COVID-19 Healthcare IT

The rise of telemedicine

We have heard much about how COVID-19 has created a paradigm shift in the use of telemedicine. A paper by Patel et al. (2021) uses claims data between January 1, 2020, to June 16, 2020 to measure this trend quantitatively. They find that in a largely commercially-insured population:

In the COVID-19 period, 30.1 percent of total visits were provided via telemedicine, with the weekly number of telemedicine visits in-creasing from 16,540 to 397,977 visits per week from the pre-COVID-19 period to the COVID-19period—a twenty-three-fold increase in telemedicine use…Despite that increase, overall visit volume decreased by 35.0 percent per week in the pre-COVID-19 and COVID-19 periods, respectively).

Unsurprisingly, individuals in higher income areas and younger individuals were more likely to use telemedicine.

What about telemedicine use by specialty? Prior to COVID-19, <2% of clinicians on average delivered outpatient care via telemedicine. Psychologists, psychiatrists and social workers, however, were early adopters of telemedicine, but use of telemedicine even in these specialties still hovered around 5% of visits prior to the COVID-19 pandemic After COVID-19, we see a significant change:

In the COVID-19period, telemedicine was used at least once by half or more of the clinicians in several specialties: endocrinologists (67.7 percent), gastroenterologists (57.0 percent), neurologists (56.3 percent), pain management physicians (50.6 percent), psychiatrists (50.2 percent), and cardiologists (50.0 percent). Specialties with the least telemedicine engagement included optometrists…[3.3 percent]…physical therapists (6.6 percent), ophthalmologists (9.3 percent) and orthopedic surgeons (20.7 percent)

Visits to treat mental health issues had the highest proportion of telemedicine use (around 50%) and number of total (i.e., in-person + telemedicine) visits actually increased after COVID-19. While some may believe common chronic conditions like hypertension and diabetes would also make good use of telemedcine; this was not necessarily the case as only 38.1% of hypertension visits and 33.9% of diabetes visits were via telemedicine. Further, the number of total visits (i.e., in-person + telemedicine) actually declined by 23.0% and 30.6% respectively after COVID-19. Potential reasons for this are: (i) individuals with these diseases are more likely to be older and less comfortable with telemedicine, (ii) these individuals may have multiple chronic conditions, for which in-person visits may be more useful, and (iii) overall visit volume fell as these individuals are at higher risk for COVID-related complications if they contract the disease.

Regardless, increased use of telemedicine is a trend that is likely to continue for many years to come.

Methods Appendix: To identify telemedicine visits, the authors used all outpatient visit claims as the denominator. As the numerator were the number of audio-video visits (outpatient claims with modifier codes GT, GQ, or 95) and audio-only telemedicine visits (CPTcodes 99441–3). All other outpatient visits were assumed to be in-person.


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