Trends in Use of Telehealth Among Health Centers During the COVID-19 Pandemic

United States, June 26-November 6, 2020

Hanna B. Demeke, PhD; Sharifa Merali, MPH; Suzanne Marks, MPH, MA; Leah Zilversmit Pao, PhD; Lisa Romero, DrPH; Paramjit Sandhu, MD; Hollie Clark, MPH; Alexey Clara, MD; Kendra B. McDow, MD; Erica Tindall, MSN, MPH; Stephanie Campbell, MPH; Joshua Bolton, MS; Xuan Le, AM; Julia L. Skapik, MD; Isaac Nwaise, PhD; Michelle A. Rose, PhD; Frank V. Strona, MPH; Christina Nelson, MD; Charlene Siza, DVM

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(7):240-244. 

In This Article

Discussion

Health centers have expanded telehealth visits considerably; nearly one third of health visits were conducted using telehealth during the study period. According to 2019 Health Center Program Data,¶¶ 43% of health centers were capable of providing telemedicine, compared with 95% of the health centers that reported using telehealth during the COVID-19 pandemic.[1] The largest increase in use of telehealth was reported in April 2020.[4,5] Following the release of Guidelines for Opening Up America Again*** on April 16, health care facilities resumed in-person visits. As COVID-19 cases declined from April to June, in-person care increased, and telehealth visits decreased.[4,5] During June through late July, telehealth visits continued to decline, but at a slower rate in the South, where the number of COVID-19 cases sharply increased. Weekly telehealth visits plateaued beginning in mid-September, concomitant with another national surge of COVID-19 cases. Although in-person visits are needed to provide timely routine care and for urgent and emergency situations, maintaining telehealth capacity is critical during the COVID-19 pandemic. Telehealth visits can facilitate patient triage, which can reduce the effect of patient surge on facilities, address limitations to health care access, conserve personal protective equipment, and reduce disease transmission.[6]

Health centers in the South and in rural areas have disproportionately experienced challenges and barriers, including the logistics of implementing telehealth, lack of partners or providers, and limited broadband access.[7] State policies to provide financial assistance for telehealth infrastructure and technical guidance to providers facilitate telehealth implementation in underserved areas.[8] Policy and practice changes under the COVID-19 Public Health Emergency proclamation[2] have enabled health centers to augment telehealth through the issuance of federal guidance and the subsequent support of federal resources. However, these additional resources might have a limited effect on barriers affecting patients, who need reliable broadband and communication devices capable of supporting telehealth as well as support on how to effectively use technology for telehealth visits.[7,9] Programs that provide access to compatible devices and incorporate technical assistance to patients for virtual care to ensure productive encounters can reduce barriers to receipt of quality telehealth services. Assessment of disparities in access to and use of telehealth across population subgroups will be important in the future.

The findings in this report are subject to at least three limitations. First, the analysis was limited to health centers that consecutively reported data to HRSA during the study period and might not be representative of all health centers. Second, the analysis was limited to unweighted averages of percentages of weekly telehealth visits because numbers of telehealth visits are not recorded in the Health Center COVID-19 Survey. Finally, the number of COVID-19 cases in counties where health centers are located might not fully reflect the effect of the COVID-19 community transmission on the health center's provision of telehealth visits.

Although resumption of in-person health care visits is anticipated, ongoing community transmission of SARS-CoV-2 might delay the transition to prepandemic levels of in-person care. Telehealth is critical to improving access to health care, especially among populations with limited access to care, and to enhancing the U.S. health care system's capacity to continue to respond to the pandemic. HRSA-funded health centers have played a critical role as primary care providers by providing testing, treatment, and preventive care, including vaccination.[10] As the COVID-19 pandemic continues, provision and expansion of health services using telehealth is critical to maintaining access to care while limiting exposure to SARS-CoV-2. Sustaining expanded use of telehealth visits in health centers during and after the pandemic might require continuation of existing flexibilities provided under Centers for Medicare & Medicaid Services telehealth reimbursement policies[2,3] and local level considerations of additional support and resources.

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