Most telehealth visits at 534 federally qualified health center care venues across California were audio only.
Health clinics serving lower-income patients have seen a surge in audio telehealth use during the pandemic, which allowed clinics to maintain access at a time when other healthcare venues saw significant drops in patient volumes, a new RAND Corporation research letter has found.
However, most of the telehealth visits at 41 federally qualified health centers operating in 534 care venues across California that were examined in the study were audio only, which RAND said raises concerns about care quality and access equity for patients, and the financial stress for clinics if payers stop paying for audio services after the public health emergency expires.
"While there are important concerns about the quality of audio-only visits, eliminating coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of clinics to meet patient needs," said study lead author Lori Uscher-Pines, senior policy researcher at nonprofit RAND.
The research letter was published Tuesday in JAMA Network.
The study found that overall visit volume at the California FQHCs held stable during the pandemic, with half of primary care medical visits from March to August done via telehealth.
More than 77% percent of behavioral health visits were conducted via telehealth over the same period. Before the pandemic, RAND found there was minimal telehealth use.
For primary care medical visits, 48.5% were by telephone, 3.4% were by video and 48.1% were in person. For behavioral health, 63.3% were by telephone, 13.9% were by video and 22.8% were in person, RAND found.
Before the pandemic, audio-only telehealth visits were rarely reimbursed by commercial payers and government programs. However, at the onset of the coronavirus pandemic in March 2020, the Centers for Medicare & Medicaid Services announced that it would temporarily reimburse FQHCs for video and audio-only telehealth services.
It's not clear if CMS or commercial payers will continue to pay for audio-only telehealth services when the PHE expires.
"Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth," Uscher-Pines said.
"These are important considerations for policymakers if telehealth continues to be widely embraced in the future."
The total number of primary care visits dropped by 6.5% during the study period, while there was no significant change in total behavioral health visits.
The use of telehealth declined slightly during the study period after spiking at the start of the pandemic. Audio-only telehealth visits peaked in April 2020, making up 65.4% of primary care medical visits and 71.6% of behavioral health visits, the study found.
Editor’s note: This story was updated on February 3, 2021.”
“Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth.”
Lori Uscher-Pines, RAND Corp..
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
Overall visit volume at the California FQHCs held stable during the pandemic, with half of primary care medical visits from March to August done via telehealth.
More than 77% percent of behavioral health visits were conducted via telehealth over the same period.
For primary care medical visits, 48.5% were by telephone, 3.4% were by video and 48.1% were in person.
For behavioral health, 63.3% were by telephone, 13.9% were by video and 22.8% were in person, RAND found.