Audio-only telehealth remains common at safety net clinics

Greater than two years into the COVID-19 pandemic, audio-only telehealth visits for each major care and psychological well being companies remained widespread at security web clinics in California, in keeping with a brand new RAND Company examine.

Though audio-only visits have declined since their peak early within the pandemic, the examine printed within the Journal of the American Medical Affiliation (JAMA) discovered that in August 2022 audio-only visits nonetheless accounted for 1 in 5 major care visits and a couple of in 5 behavioral well being visits amongst individuals who acquired care at Federally Certified Well being Facilities in California.

Researchers say the upper charges of audio-only telehealth in security web settings raises questions in regards to the high quality of care and fairness for low-income sufferers, for the reason that effectiveness of audio-only telehealth has not been established.

“It’s probably that these security web clinics continued to ship audio-only visits in excessive quantity due to their position in enhancing entry to well being companies,” stated Lori Uscher-Pines, lead creator of the examine and a senior coverage researcher at RAND, a nonprofit analysis group. “Our examine raises necessary questions on what sort of position we would like audio-only visits enjoying within the care of deprived populations and the general public usually going ahead.”

The onset of the COVID-19 pandemic prompted many payers to start reimbursing security web clinics for telehealth companies supplied by video or audio-only expertise. Beforehand, the clinics hardly ever acquired cost for telehealth companies delivered on to sufferers.

RAND researchers examined the experiences of 30 multisite Federally Certified Well being Facilities in California that present take care of 1.3 million lower-income folks. Most of the clinics are positioned in rural areas of the state. The examine included details about billable in-person and telehealth (video and audio-only) visits from February 2019 to August 2022.

The examine discovered that that variety of major care visits elevated by 8.5% from February 2020 to August 2022, whereas the variety of whole behavioral visits elevated 23% throughout the identical interval. The will increase are probably the results of having the ability to extensively supply telehealth companies, even because the clinics misplaced employees members.

Researchers discovered that audio-only telehealth visits for major care companies peaked in April 2020, whereas audio-only visits for behavioral well being peaked in March 2021.

Inside major care, the decline in audio-only visits from the early pandemic peak seems to coincide with the return of in-person visits relatively than progress in video visits.

For major care, the proportion of in-person visits elevated from 30% in April 2020 to 71% by August of 2022. Over the identical interval, audio-only visits decreased from 67% to 21%, whereas video visits elevated from 4% to 7%.

For behavioral well being, the proportion of in-person visits elevated from 20% in April 2020 to 37% in August 2022. Throughout that interval, audio-only visits for behavioral well being care decreased from 74% to 39%, whereas video visits elevated from 8% to 23%.

Researchers say that Federally Certified Well being Facilities’ continued use of audio-only telehealth could also be a results of the clinics and their sufferers not accessing the expertise wanted for video telehealth. As well as, since California’s Medicaid program (Medi-Cal) granted everlasting cost parity for audio-only visits, there aren’t any monetary incentives for the clinics to restrict audio-only visits.

“It seems probably that audio solely visits in these settings will stay widespread in coming years,” Uscher-Value stated. “Extra analysis is required on the effectiveness of audio-only visits to tell their use in security web settings.”