Coronavirus: Study Measures Telemedicine Growth and Outpatient Visit Contraction

In the first half of 2020, the total number of telemedicine and in-person outpatient visits decreased 9.1%, raising concern about deferred care.

A recent research article gauges the increase in telemedicine patient visits and decrease in outpatient in-person visits in the first half of the year.

Largely to reduce the spread of the novel coronavirus, hospitals and physician practices have increased utilization of telemedicine for patient visits and decreased in-person visits. The increase in telemedicine visits has been colossal. For example, a FAIR Health analysis of commercial insurance claims data found telehealth claims lines increased 3,552% from August 2019 to August 2020.

The recent research article, which was published by JAMA Internal Medicine, is based on information from a national sample of 16.7 million people with commercial or Medicare Advantage health plans. The researchers examined telemedicine and in-person outpatient visits from Jan. 1 to June 16.

The study has several key data points:

• The weekly rate of telemedicine patient visits increased sharply in the early phase of the pandemic—peaking in the week of April 15
   
• From the weeks of Jan. 1 to June 10, the rate of telemedicine visits increased 2,013%, rising from 0.8 to 17.8 visits per 1,000 health plan enrollees
   
• From the weeks of Jan. 1 to June 10, the rate of in-person outpatient visits decreased 30.0%, falling from 102.7 to 76.3 visits per 1,000 health plan enrollees
   
• During the study period, the total number of telemedicine and in-person outpatient visits decreased 9.1%, falling from 103.5 to 94.1 visits per 1,000 health plan enrollees
   
• In the last month of the study period, there was significant geographic variation in the percentage of total visits conducted through telemedicine, ranging from 8.4% in South Dakota to 47.6% in Massachusetts

"Although there was geographic variation in the magnitude of changes, every state experienced a drop in total visits, illustrating the broad scope of deferred care during the first months of COVID-19," the study's co-authors wrote.

Interpreting the data

The nationwide level of deferred care is alarming, one of the study's co-authors told HealthLeaders.

"Deferred care is potentially a very big problem that will disproportionately harm vulnerable populations, further exacerbating all of the racial and social inequity that the pandemic has laid bare. My biggest concerns are worsened chronic disease management—like diabetes—that could take years to reverse and a very big backlog of overdue cancer screening resulting in an increase in preventable cancer deaths," said Michael Barnett, MD, MS, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health in Boston.

The level of outpatient in-person visits is likely to ebb and flow with the varying intensity of the coronavirus pandemic, he said.

"Early data is suggesting that outpatient volume is coming back to the pre-COVID baseline in the second half of 2020, but that data is from before the current surge we are all experiencing right now. Outpatient delivery may be riding a bit of a wave up and down as COVID-related restrictions are tightened and loosened over the next several months."

Related: AMA Coronavirus Survey: Physician Practice Revenue Down 32%