Surgeon Telehealth Use Surges With Pandemic, Then Drops Off Some

By Linda Carroll

March 29, 2021

(Reuters Health) - Early in the COVID-19 pandemic, surgeons' use of telehealth rose across all surgical specialties, but rates declined as in-person care resumed, though they remained above pre-pandemic levels, according to a new study of trends in Michigan.

An analysis of data from 4,405 Michigan surgeons revealed that at its peak, telehealth was used in nearly 35% of new patient visits, according to the report published in JAMA Surgery.

"We didn't know if it would work in surgery," said the study's lead author, Dr. Grace Chao, a general surgery resident at the Yale University School of Medicine, in New Haven, Connecticut, and a research fellow through the National Clinician Scholars Program at Veterans Affairs in Ann Arbor, Michigan, and the Institute Health Care Policy and Innovation at the University of Michigan. "Our study finds that there were actually a lot of patients able to access surgeons during the pandemic through telehealth."

Although use has dropped off, Dr. Chao hopes that surgeons will be willing to offer at least a small portion of visits via telehealth. What may be holding telehealth back is that "a lot of patients and surgeons still want that in-person interaction," Dr. Chao said.

To take a closer look at telehealth use among surgeons, Dr. Chao and her colleagues turned to claims from a large Michigan commercial insurance payer. The plan covers 3.5 million individuals per year, of whom approximately 700,000 saw a surgeon in 2019. The researchers focused on new patient visits with a surgeon from one of nine surgical specialties during each of the following periods: prior to the COVID-19 pandemic (period one: January 5 to March 7, 2020), early pandemic (period two: March 8 to June 6, 2020), and late pandemic (period three: June 7 to September 5, 2020).

The researchers defined "conversion rate" as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019, which adjusts for a substantial decrease in outpatient care during the pandemic.

Among the 4,405 surgeons in the cohort, 2,588 (58.8%) performed telehealth in any patient care context. Specifically looking at new patient visits, 1,182 surgeons (26.8%) used telehealth. A total of 109,610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 years compared with 52.6 years for patients who received care in-person.

Prior to March 2020, less than 1% of new patient visits (8 of 173,939) were conducted through telehealth. Use of telehealth peaked in April 2020 (week 14) with 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume.

During the second period, a mean of 16.6% of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes).

During the third period, 3.0% (2,168 of 71,819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). The mean telehealth conversion rates varied by specialty, with urology and neurosurgery by far the highest.

A couple of interesting things came out of this study, said Dr. Simon Mathews, a digital health researcher and an assistant professor of medicine at Johns Hopkins School of Medicine, in Baltimore, who wasn't involved in the research.

"First, the overall utilization was pretty low," Dr. Mathews said. "The data here show even at the peak period it was just 16.6%."

If there was ever a time for telehealth to flourish it would be during a pandemic, Dr. Mathews said. "You can't get much bigger of a structural shift that would motivate people to try alternative opportunities for care delivery than with a pandemic," he added. "With parity in reimbursement, if there was a time for telehealth to make a big leap, it would be during the pandemic."

The other interesting finding, Dr. Mathews said, is "the heterogeneity across subspecialties. "This study introduces more questions than answers. Why are these subspecialties able to make it happen at much greater rates than the others?"

The telehealth rates reported in the study do seem low, said Dr. Robert Bart, chief medical information officer at UPMC in Pittsburgh.

"Nationally, around 15% of all ambulatory visits are being done with telehealth," Dr. Bart said, adding that at UPMC, surgical telehealth visits range from the high single digits to around 17%.

"Prior to the pandemic UPMC worked at getting surgeons to accept telehealth," Dr. Bart said. "The specific reason is that UPMC is a referral center. Some patients have to travel two to three hours to get here. And it didn't make sense to have them travel here for post-operative visits. The last thing anyone wants seven to 14 days after surgery when they're still in pain is to get in the car to see their surgeon (for a quick visit)."

Overall, at UPMC 17% to 20% of ambulatory visits are done with telehealth, Dr. Bart said. "The philosophy we have here is if the interactions can be conducted at the same quality with telehealth as they can be face-to-face, we try to push our clinicians to move in that direction if the patients are comfortable with it."

SOURCE: https://bit.ly/3lVmykZ and https://bit.ly/3rqEjtQ JAMA Surgery, online March 26, 2021.

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