Even though audio-only telehealth visits have declined since the onset of the pandemic, the practice appears to remain popular among safety-net settings, a new study found.
The study, published by RAND, could have an impact on what telehealth flexibilities become permanent after 2024 when pandemic-related changes expire.
“Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public, in general, going forward,” said Lori Uscher-Pines, Ph.D., the study’s lead author, in a statement.
At the start of the pandemic, the Centers for Medicare & Medicaid Services (CMS) relaxed certain restrictions that enabled providers to get reimbursement for audio and video telehealth visits. Safety-net clinics rarely got reimbursement for telehealth, the RAND study said.
Researchers looked at 30 federal health centers in California that offer care for lower-income individuals. It looked at billable in-person and telehealth (video or audio) visits stretching from February 2019 through August 2022.
Primary care audio-only visits increased by 8.5% from February 2020 through August 2022. Behavioral visits also increased by 23% for the same time period.
The study found that the increases appeared to peak in April 2020 for primary care services and March 2021 for behavioral health care. The increases may have leveled off as in-person visits returned rather than an increase in video visits.
The continued use of audio-only telehealth may be linked to “the clinics and their patients not having access to the technology needed for video telehealth,” a release on the findings said.
California’s Medicaid program had also called for pay parity between audio and video visits, which ensures there are no financial incentives for a clinic to limit the practice.
“It appears likely that audio-only visits in these settings will remain widespread in coming years,” said Uscher-Price.
RAND’s study comes as CMS and Congress are trying to figure out what services are likely to become permanent.
Congress has debated how to address what flexibility should remain.
For instance, lawmakers wrote to federal agencies back in October to extend telehealth flexibilities for prescribing medication-assisted treatments to combat opioid abuse. Part of the concerns stemmed from whether the audio-only telehealth will stick around.
Originally, the flexibilities were supposed to remain in place through the end of the COVID-19 public health emergency, which ends May 11. However, lawmakers have extended the telehealth flexibilities through December 2024 in order to help understand what should be permanent.