COVID-19 caused a pandemic and, with it, an unprecedented expansion of telehealth among U.S. medical groups, health systems and hospitals.
Now with the COVID-19 public health emergency (PHE) set to end later this month, there are some answers but still plenty of questions centered around one key worry: What is the future of telehealth in the post-COVID-19 environment?
To understand this, a May 2, 2023, MGMA Stat poll asked medical group leaders what shifts they saw in patient demand for telehealth so far this year. As it turns out, the prognostications of telehealth flourishing like a genie loosed from a bottle are a mixed bag: Nearly two-thirds (64%) noted that patient demand has decreased from the beginning of the year, whereas 14% noted an increase in its popularity and 22% reported that demand has stayed about the same. The poll had 511 applicable responses.
These results represent a significant shift from a Nov. 3, 2022, MGMA Stat poll that found almost half (45%) of medical group leaders predicting no change in patients’ demand for telehealth this year, with the remaining respondents split between expecting an increase (27%) and a decrease (28%).
From new normal to old normal?
While telehealth was a crucial lifeline for patients and providers during the height of COVID-19 lockdowns, the severity of seeing patients shifting away from virtual visits has been limited according to practice leaders who responded to this week’s poll.
Several respondents noted that they have seen little to no impact on staffing or workflows, as many physicians and patients alike express a desire for in-person care again amid the perception of COVID-19 being under control. As commercial payers have stopped reimbursing for certain types of telemedicine, reimbursement for traditional in-person care delivery has typically offset the lost telehealth volume.
The most common complaint about the return to non-virtual appointments was the familiar worry about labor shortages — more patients returning to outpatient clinics necessitates more clinical support staff.
“We have a lot of patients that want to see someone in person; however, we don't always have enough staff to accommodate that so have been trying to push the televisits,” one practice leader told MGMA.
For other medical groups, reining in telehealth appointments has made a positive impact on scheduling by using fewer templates overall and no longer block-scheduling telehealth appointments. Some practices reported higher no-show rates for virtual visits, so a shift to more in-person care has left them with fewer open appointment slots overall, as well as with the ability to do more diagnostic testing, imaging, injections and various on-site ancillary services.
Is stability in sight?
Practice leaders who reported telehealth demand remaining the same throughout this year anticipate much more of the same. When asked if they expected a shift through the end of the year, 90% said “no,” with only 10% theorizing a potential boost on account of the potential for a very bad flu/RSV/COVID-19 spike in the latter half of 2023, or continued work to allow licensing for providers across state lines.
These respondents largely echoed the thoughts of those that have seen patient telehealth demand decrease this year: “People either want it or not,” one practice leader told MGMA. “There is still some resistance with both providers and the public to telehealth in our region,” another respondent said. “However, this may also change as our leadership pushes more electronic avenues for interacting with our patients."
Where telehealth demand is growing
FAIR Health’s Monthly Telehealth Regional Tracker has kept a tally on monthly changes in telehealth claim volumes, as well as urban versus rural differences in audio-only telehealth usage, and top diagnoses for different forms of telemedicine (e.g., live video and asynchronous telehealth).
The latest month of available data found that telehealth as a percentage of all medical claim lines dropped from 5.9% in January 2023 to 5.5% in February — or roughly the same level noted in December 2022. As noted by Healthcare Dive, telehealth claims in January were highest in the Midwest and West (about 9.5% of all regional claims) and lower but on the rise in the South (6.7%) and the Northeast (3.2%).
Among the practice leaders responding to this week’s poll that noted an increase in patient demand for telehealth, most reported they have had some staffing and workflow changes to manage the spike — largely because they anticipated a shift back to in-person care. “We planned to shift more providers back to office visits if utilization fell; we still might if demand falls, but it's been steady,” one practice leader told MGMA.
Some of the most common changes to handle ongoing demand for telehealth included updates to phone systems to support an increase in audio-only reimbursements, and improvements to cloud phone systems to support an increase in asynchronous telehealth and image sharing.
Telehealth seasonality: Is it COVID or something else?
Previous reporting on telehealth claims have found spikes in utilization during the winter months, especially the “perfect storm” of high patient demand and reduced provider availability during the Omicron surge during the 2021 holidays.
However, COVID-19 case numbers have stayed relatively low, and the impacts to provider staffing because of pandemic illnesses were especially low this past winter amid the so-called “Kraken” variant: Half of medical groups (50%) reported their workers taking less sick/COVID-19 leave during the month of December 2022 versus the same period in 2021.
Post-PHE resources for MGMA members
- MGMA Government Affairs’ resource on key flexibilities and policies that will expire after the end of the COVID-19 PHE has been updated to reflect the May 11 end of the PHE.
- MGMA members can also watch the on-demand video of the GovChat Live presentation, “Unwinding of the Public Health Emergency (PHE).”
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