A new report from the Commonwealth Fund found a "plateau" in the growth of telemedicine visits, accounting for a relatively small percentage of rebounding ambulatory care services.

As states experiment with reopening – and re-closing – their economies in response to concerns around coronavirus, continuing attention has been paid to skyrocketing rates of telehealth visits.   

But the report found that telemedicine visits have actually been declining since April, suggesting that health providers are still finding the best ways to provide virtual services.  

"Telemedicine cannot replace all types of visits – for instance, in-person visits are still necessary to diagnose and test certain complex conditions," said Commonwealth Fund SVP for policy and research Dr. Eric C. Schneider and VP for delivery system reform Tanya Shah in a blog post accompanying the report. 

"While these results are from a sample of practices accounting for approximately 5 percent of ambulatory visits in the U.S., it seems likely that their experiences are typical, and most practices are facing similar challenges," they said.

WHY IT MATTERS  

Fears around community transmission of coronavirus have led to a number of shifts in patient behavior, including forgoing in-person visits for nonemergency medical needs.  

Although this has led to an unprecedented growth in telemedicine, the Commonwealth Fund report said, it also means Americans are deferring necessary care for chronic conditions.  

"The health of Americans is at risk because of reduced access to services," said Schneider and Shah. "Childhood vaccines have been delayed; visits to pediatric practices remain 34 percent below pre-crisis levels."

"Patients with chronic conditions may have missed out on timely diagnoses, lab testing, and adjustments to medications that prevent worsening health," they continued.

For the report, researchers from Harvard University and the healthcare software company Phreesia analyzed data from 50,000 Phreesia clients. They found that overall visits to ambulatory practices are still 10% below baseline numbers from the week of March 1.

Although that rate has rebounded substantially from the 60% decrease in late March, it is still "substantially lower," report authors said, from pre-pandemic levels. 

"Forgone visits have created 'cumulative deficits' in both patient treatment and practice revenue," read the report.  

In mid-April, according to the report, telemedicine visits accounted for 14% of the number of visits in the baseline week – compared with 0.1% in the week of March 8. Since then, that rate has been declining, with virtual care in the week of June 14 accounting for 7.4% of the number of baseline visits.  

Report authors noted that the nature of the research may have resulted in an underestimation of telehealth rates.   

"It is possible some unscheduled telephone encounters may not be captured if they were not recorded in the scheduling software," they wrote.  

"In addition, early in the pandemic, providers were still creating processes to designate telemedicine visit types in their scheduling software. As a result, the fraction of all visits identified as telemedicine may be underestimated," they continued.  

THE LARGER TREND  

The future of telemedicine remains an open question, particularly as lawmakers wrestle with which temporary regulations to enshrine into permanence.   

At last week's American Telemedicine Association conference, ATA President Dr. Joe Kvedar said that telehealth advocates have a "lot more work to do" in terms of making virtual care accessible in the long term.  

He encouraged attendees to think beyond more traditional one-on-one real-time visits, such as through remote-monitoring devices and asynchronous, "one-to-many" models that will allow for more efficient care.  

Kvedar also told Healthcare IT News that integrating virtual care with in-person visits will be an ongoing challenge. As the Commonwealth report authors noted, it's not feasible to expect all visits to be conducted via telemedicine.  

"I keep telling people to rethink what they need to make a decision," Kvedar said, about striking a balance between the two models. "You don't [always] have to touch a patient to make that decision."   

ON THE RECORD

"The COVID-19 pandemic has disrupted outpatient practices over the past three months, with especially persistent impacts on pediatric, behavioral health, and pulmonary practices. As patients return to care, data and stories suggest that many practices are continuing to recover and adapt," said Schneider and Shah.  

"A combination of fearful patients who may be unable to afford care, the need to make necessary but costly modifications to practices, and reductions in fee-for-service revenue may damage the financial well-being of practices, threatening access to care for patients now and perhaps into the future," they continued.  

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.