35 million visits make the case that virtual visits can stand alone, even in medical specialties–but how much was the pandemic a factor? Epic Research, a public benefit corporation owned by Epic Systems Corporation, analyzed telehealth consults over 26 months in a dual team study. The study found that most patients did not require an in-person follow-up appointment in that specialty within 90 days. The dual team study (two teams working independently) reviewed US EHR data collected from 1 March 2020 through 31 May 2022.
There was an extremely wide spread by specialty both in the number of visits and in-person follow-up within the three-month window.
Looking at the study findings:
- The lowest in-person follow-up percentage was in genetics at 4%, followed by nutrition at 10%; the highest–unsurprisingly–was obstetrics at 92%.
- Far and away, the specialty with the greatest number of telehealth visits, over 4.3 million, was mental health and psychiatry. Their in-person follow-up was 15% of that number. That ‘cadence of care’ cited in the study report could be in part due to state medical regulations and insurance guidelines requiring in-person review, especially when prescribing Schedule 2 (those with a high possibility of abuse and dependence) or even Schedule 4 drugs.
- Other specialties falling below 25% of in-person follow-up were endocrinology and neurology (both with 1 million telehealth visits), plus diabetes services, nephrology, pulmonology, medication management, gastroenterology, rheumatology, and addiction.
- Cardiology and surgery, with both at 1.4 million telehealth visits, surprisingly had follow-up percentages around 43%
- Above 50% in follow-up are geriatrics and fertility, both of which require more in-person examination. Geriatrics also covers a broad range of chronic condition care management in patients.
In looking at the numbers, this Editor will point to three situational factors unique to the pandemic period and its aftermath that may skew these findings on in-person follow-up visits to a lower range:
- Most medical offices in the US closed from the start of the pandemic (about March 2020) and did not reopen until mid-year. Many health specialty practices and psychiatric clinics did not reopen for in-person visits until the fall or even later.
- Online mental health consults took off like a rocket–and are coming back to earth with greater scrutiny of prescribed Schedule 2 drugs (see Cerebral Health, Talkspace, et al.)
- Continuing patient apprehension on in-person visits into this year
- The continuing of public health emergency (PHE) compensation for telehealth visits into 2022 both in Medicare and private insurance
A flaw in the article is that these points are not considered in influencing in-person visits in the future.