- Telehealth visits that exploded in recent months are starting to plateau and in some cases decline in popularity as doctor's offices reschedule backlogged patients for more in-person appointments, according new data from The Commonwealth Fund. Telemedicine visits accounted for about 14% of all total visits the week of April 19, according to the report, but that number dropped to 13% the next week and 12% the week after that. Telehealth visits held at 12% for the first two weeks of May.
- Primary care practices especially are grappling with telehealth's limitations, said Farzad Mostashari, CEO of Aledade, a startup that helps practices develop new payment models. Minor procedures involving sutures and stitches, for example, are revenue-driving primary care services that can't be done virtually.
- Though nowhere near pre-pandemic levels, outpatient visits are on the rebound across the country, the report found, and appear largest in the south central region that includes Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, Tennessee and Kentucky.
In response to the pandemic, CMS waived some telehealth regulations and increased payments to providers using the technology. But after two months, some doctors are starting to bring patients back in for services they can't provide online.
Researchers looked at data from more than 50,000 providers' practice management and scheduling software, EHRs and online check-in platforms to measure the rebound in outpatient visits at primary care practices and other clinics.
Within that data they looked at demographic information, such as age and location. It also found that older adults are returning to practice settings at higher rates than other age groups, especially compared to school age children.
Typical services provided by primary care physicians that can't be performed over telehealth are coming into focus, such as administering vaccines to children, or remotely monitoring blood pressure in older people, as CMS doesn't pay for home blood pressure monitors, Mostashari said during a Commonwealth webinar Wednesday.
Primary care practices and their impact on public health are important to consider separately from other parts of the struggling healthcare system as they work to bring back business, he said.
Failing to bring patients back in for those revenue-driving services and letting the clinics go under would be devastating to care access, and could lead to a second pandemic of untreated chronic conditions. "If you don't do prevention you will pay the price in complications," Mostashari said.
About half of primary care is delivered outside of major health systems, he said, though that number is quickly shrinking as health systems continue to gobble up the private practices, according to the American Medical Association.
Remaining independent practices that have resisted selling to hospitals have razor thin margins and need more federal funding directed specifically to them, said Melinda Abrams, senior vice president for delivery system reform and international innovations at The Commonwealth Fund.
COVID-19-related state budget constraints could permanently close small, independent practices, especially in rural communities, she said.
It's still unclear exactly where all the provider relief funding is going, though for-profit, higher-margin hospitals seem to be at an advantage.
Mostashari noted that it's been harder for primary care practices to comply with "seemingly modest requests" to disclose their finances before receiving relief funds, compared to bigger systems with accounting departments that issue regular reports.