Telemedicine Offsets Some Drop in US Outpatient Visits During COVID-19

By Lisa Rapaport

November 17, 2020

(Reuters Health) - An increase in telemedicine visits in the U.S. during the COVID-19 pandemic has offset some of the decline in outpatient care, although use of telehealth varies by state, a study of commercially insured patients suggests.

Researchers examined insurance claims from the OptumLabs Data Warehouse on all outpatient visits from January 1 to June 16, 2020 for 16,740,365 individuals with commercial insurance.

From the weeks of January 1 to June 10, total outpatient visits for both telemedicine and in-person care declined from a weekly rate of 103.5 per 1,000 enrollees to 94.1 per 1,000. Over this same period, telemedicine weekly visit rates increased from 0.8 per 1,000 enrollees to 17.8 visits per 1,000 and in-person visits decreased from 102.7 per 1,000 enrollees to 76.3 visits per 1,000.

"I think the major take-away is that telemedicine is a new normal for health care delivery, but that, as a country, we will have a huge amount of health care to catch up on given the large drop in doctor visits that we saw," said senior study author Dr. Michael Barnett, an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health in Boston.

"It will be hard to catch up, but our health system has to develop new ways to make up for this lost time, like expanding telephone and community-based outreach," Dr. Barnett said by email.

Telemedicine visits peaked during the week of April 15, then declined by the week of June 10, the study team reports in JAMA Internal Medicine.

While telemedicine visits increased during the study period by 2013%, total visits (in-person plus telemedicine) were down overall by 9.1%, the authors note.

Over the last four weeks of the study, the proportion of total outpatient visits done via telemedicine also varied widely across the U.S., from as low as 8.4% in South Dakota to as high as 47.6% in Massachusetts.

One limitation of the study is that results from a commercial insurance population might not be generalizable to other groups, such as the uninsured or individuals covered by Medicare or Medicaid, the study team notes.

Still, the increased uptake of telemedicine during the initial peak of the COVID-19 pandemic earlier in the year, followed by a decline near the start of summer, suggests that this is a reasonable alternative to in-person visits for routine care, said Dr. Michael Albosta of Central Michigan University College of Medicine in Saginaw.

"Telemedicine is convenient, in that it reduces travel time to and from appointments.," Dr. Albosta, who wasn't involved in the study, said by email. "Further, telemedicine may allow for providers to expand access to care for populations with limited access to primary care providers, such as certain parts of rural America."

At the same time, the fact that telemedicine didn't entirely offset the decline of in-person visits during the pandemic suggests that there may be short-term and long-term consequences from delays of necessary care, said Dr. Sonu Bhaskar of Liverpool Hospital and NSW Brain Clot Bank in Sydney, Australia.

"The decrease in outpatient volume or deferred care during the pandemic should raise red flags among clinicians," Dr. Bhaskar, who wasn't involved in the study, said by email. "Clinicians need to be more engaged with patients who are unable or unwilling to seek outpatient care."

SOURCE: JAMA Internal Medicine, online November 16, 2020.