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Telehealth and primary care: Most virtual visits don’t lead to in-person appointments


An Epic analysis shows in most telehealth visits for primary care, patients did not need to see their doctor in person. Danessa Sandmann of Epic Research talks about the study and its implications.

Some healthcare providers and industry analysts have wondered if telehealth would reduce the number of in-person appointments, or if patients would still want to go to their doctor after a virtual visit.

Telehealth usage skyrocketed during the COVID-19 pandemic. While many tout telehealth for its ability to reach more patients in a convenient way, some have worried that it won’t lead to more efficiency if patients end up asking to see their doctor in person for a follow-up appointment afterwards.

However, an analysis by Epic shows in most telehealth visits for primary care, patients have not required an in-person appointment within 90 days.

Epic examined 18.6 million primary care telehealth visits between March 1, 2020 and October 15, 2022. In 61% of the cases, patients didn’t need to go visit their doctor in person within 90 days. Epic looked at family medicine, pediatrics and internal medicine.

Danessa Sandmann, head of operations for Epic Research, tells Chief Healthcare Executive® the study of primary care was illuminating, and a bit surprising.

“I do think the hypothesis that many held was that specifically in primary care that people more often than not would likely need to come back in for some sort of appointment,” Sandmann says.

“And that volume was, I think, a lot lower than people expected specifically in primary care,” she adds.

The telehealth study offers more evidence that virtual care can provide an alternative that patients appreciate and can also serve the needs of providers.

“I think it really helps to underscore that telehealth can be a meaningful interaction with the patient and the provider, such that they might be able to resolve whatever concerns they have or get the treatment that they need in that telehealth space, such that it can be an alternative means of meeting with their provider rather than a duplicative means of meeting with their provider,” Sandmann says.

(See part of our conversation with Danessa Sandmann of Epic in this video. The story continues below.)

Success in pediatrics

Previously, Epic examined the use of telehealth in specialty care, and most specialty telehealth appointments didn’t require an in-person visit. In mental health, only 15% of patients who had a virtual visit needed to see a doctor in person within 90 days.

But Sandmann says she and her fellow researchers were anxious to see if there would be similar results in primary care.

“That was one of the reasons why we looked at primary care separately,” Sandmann says.

“We know that the type of care that patients receive in primary care specialties, and with family medicine and pediatric and internal medicine, looks a little bit different than specialty care in some of those areas," she explains. "So we thought it was important to be able to kind of differentiate what those experiences were.”

Telehealth visits in pediatrics required the largest percentage of follow-up appointments in person in the primary care study, and that probably isn’t surprising. Parents are likely to push for a follow-up for their kids, and doctors may be more inclined to see a child in person.

But even in pediatrics, more than half of the telehealth appointments (54%) did not require an in-person appointment within the following 90 days.

“I think that was one of the most interesting findings,” Sandmann says.

Obviously, some pediatric appointments are going to have to involve visiting the doctor in person, such as immunization. But telehealth appointments can offer parents an easier time, while also helping organizations see more patients.

“It can be especially challenging for pediatric visits, where a parent or guardian needs to accompany a child to the doctor and bring them in and do a lot of those other types of things,” Sandmann says. “So it's interesting to see that they're able to potentially resolve a number of their health concerns via telehealth.”

Epic’s team also evaluated telehealth visits involving patients with different healthcare coverage. Overall, the results were fairly consistent. Whether the patient had commercial insurance or relied on Medicare or Medicaid, they typically didn’t need an in-person appointment after telehealth.

Among patients with commercial insurance, 63% of those who had a virtual visit didn’t have an in-person appointment within 90 days. More than half of Medicare and Medicaid patients (55%) didn’t need an in-person visit after a telehealth appointment, the study found.

“It was interesting to see that there really wasn't all that much difference between the Medicare and Medicaid covered populations and the privately insured populations,” Sandmann says.

Noting the usage of virtual care among Medicare beneficiaries, Sandmann said she was encouraged that older patients are taking advantage of telehealth.

“Even with that population, they were still able to avoid needing to come in within those following three months, for a lot of those conditions,” she says.

And that offers “really exciting opportunities to really increase access to care,” Sandmann says.

Self-pay patients were the least likely to see a doctor in person after a telehealth appointment. More than three out of four (76%) self-pay patients had no in-person appointment within 90 days.

Takeaways for leaders

Healthcare organizations and doctors need to make sure they can see patients in person when necessary, but they should embrace the possibilities of telehealth.

Sandmann suggests providers should “create these opportunities to see patients via telehealth and understand how that might impact their workload and their ability to meet with patients.”

Organizations that are having the most success with telehealth are offering “flexible front-end scheduling” for patients, Sandmann says. Some patients know they would prefer a virtual appointment, especially if that means they could see a doctor more quickly. So providers should offer patients the option of telehealth or an in-person visit when they are scheduling an appointment.

She also stresses the importance of appropriately assessing if the patient’s needs can be met in a virtual visit or if the patient needs to see a doctor in person.

Sandmann said she thinks health systems can use the study to assess whether they need to expand their telehealth options. “This data can help them kind of really understand what it might mean for them to open up more telehealth spaces,” Sandmann says.

While many patients will need to be seen in person, health systems and physicians should look at what can be achieved through telehealth, she says.

“There are things that are much more suited for telehealth and potentially could be resolved via a telehealth visit, versus some of the other things that might need to happen in person,” she says.

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