A Commonwealth Fund/Harvard University/Phreesia tracking study of outpatient visits in 50,000 US healthcare practices, specialty as well as primary care, has tracked the effect of the COVID pandemic on practice visits during the period 8 March through 20 June. Using as their baseline the week of 1-7 March, which was the last ‘normal’ week in line with February, the results are not unexpected:

• From 15 March to 20 June (three months), practice visits, including telehealth, plummeted 37 percent
• Disproportionately affected were pediatricians, pulmonologists, and surgical specialties such as orthopedics
• Against the baseline, week of 14 June visits are still down 11 percent
• The nadir was 29 March, off 59 percent
• The rebound tracks the same by US region, with the least dip in South Central and Mountain regions. (The most affected, of course, are New England-Mid-Atlantic and Pacific, with the highest COVID rates and the least rebound.)
• Looking at the ‘rebound week’ of 14 June, the effects linger on in pediatrics, pulmonology, and (interestingly) behavioral health. (Anecdotally, behavioral health patients are continuing with telehealth for convenience versus the physical visit.)
• Telehealth visits took off starting 8 March and at their peak were 13.9 percent of visits (19 April)
• Since 26 April, telehealth visits have declined as in-person visits resume, and are at 7.4 percent as of 14 June (46.7 percent less). However, compared to the baseline of nearly zero (0.1 percent), it’s nearly a 140 percent increase.

Phreesia is a scheduling and patient check-in platform. The practices surveyed are Phreesia clients, covering 1,600 provider organizations, with 50,000 providers in 50 states.

Physicians were also interviewed as part of the study. The office operation has had to change, and the patient experience in returning to practices is very different. Making up deferred care is complicated, and precautions to mitigate risk of viral transmission inevitably slow care down. 

Much of the press around this study is that telehealth is receding quickly. As a trend in an extraordinary time when there was no alternative, as practices reopen a shift back to the office is to be expected, and often there is no substitute for in-person exams and procedures. Still, there are elements of long-term uncertainty on the future of practice telehealth. Both CMS and payers announced that payments for telehealth (audio/visual and telephone only) would remain in place only for the duration of the pandemic. What are their long term plans? Providers are having difficulty getting paid or paid enough even in parity states. State Medicaid presents even more of an unwanted ‘discount’.  Telehealth also demands a commitment to (ultimately) a HIPAA-compliant platform, workflow/staff support, and input in the practice’s EMR/population health platform. STAT, HealthcareITNews

The American Telehealth Association (ATA), coming off their virtual annual meeting last week, sent a letter to Congress with 340 signatories supporting a permanent expansion of telehealth after the public health emergency (PHE) ends in four priority areas:

• Remove location restrictions 
• Maintain HHS authority to determine eligible practitioners who may furnish clinically appropriate telehealth services
• Authorize Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) to furnish telehealth services 
• Make permanent the HHS Temporary Waiver Authority to respond to emergencies

Release and letter