In-Person Follow-Ups Higher After In-Office Visits Than Telehealth

Across most specialties, rates of in-person follow-up within 90 days were higher for in-office visits than telehealth visits, according to new research.

Conducted by Epic Research, the study involved an analysis of data from Cosmos, a HIPAA-defined limited dataset of more than 190 million patients from 208 healthcare organizations using the Epic EHR system across the United States and Lebanon.

Researchers examined 40.68 million specialty visits and 32.14 million primary care encounters from January 2022 to March 2023. They did not include specialties with fewer than 400,000 encounters during the study period.

The research shows that visits within 16 out of the 24 specialties studied resulted in in-person follow-ups within 90 days after an office visit more often than after a telehealth visit.

The in-person follow-up rates were highest for mental health-, physical medicine and rehabilitation-, and pain medicine-related office visits compared to telehealth. Mental health office visits had a 40.3 percent in-person follow-up rate versus mental health-related telehealth visits, which had a 9.8 percent in-person follow-up rate.

The in-person follow-up rate for physical medicine and rehabilitation office visits was 24 percent higher than that of telehealth visits, while pain medicine office visits had a 20.5 percent in-person higher in-person follow-up rate.

Podiatry, obstetrics and gynecology, and ophthalmology were on the other end of the spectrum.

The in-person follow-up rate after telehealth visits for podiatry was 12.6 percent higher than office visits. For obstetrics and gynecology, and ophthalmology, the in-person follow-up rate after telehealth visits was 9.2 and 9.1 percent higher, respectively, than office visits.

Specialties such as allergy and immunology, dermatology, and ENT also had slightly higher rates of in-person follow-up after telehealth visits than office visits.

Within the primary care arena, the difference between in-person follow-up rates for telehealth and in-office care was relatively small.

Internal medicine telehealth visits had a 2.1 percent higher rate of in-person follow-up than office visits, while pediatric telehealth visits had a 0.8 percent higher rate. But conversely, family medicine office visits had a 0.2 percent higher rate of in-person follow-up than telehealth visits.

The new analysis follows studies by Epic Research examining in-person follow-up rates for primary care and specialty care-related telehealth visits.

In December 2022, Epic Research released a study that analyzed 35 million telehealth visits between March 1, 2020, and May 31, 2022. They found that in nearly every specialty studied, most telehealth patients did not require an in-person follow-up appointment in that specialty in the three months following the virtual visit.

The specialties with the lowest rates of in-person follow-up appointments were genetics, nutrition, and endocrinology. In contrast, those with the highest rates were obstetrics and virtual fertility, with 92 percent and 54 percent of patients, respectively, needing an in-person visit three months after a telehealth appointment.

An Epic Research study published in March shows that most primary care-related telehealth visits did not require an in-person follow-up visit.

For the study, researchers reviewed 18.6 million telehealth visits for primary care between March 1, 2020, and Oct. 15, 2022. The data assessed included family medicine, general internal medicine, and pediatric primary care visits.

The researchers found that 61 percent of primary care telehealth visits did not require an in-person follow-up within three months in the same primary care specialty. The study also revealed that pediatric primary care visits were the most likely to require an in-person visit following a telehealth visit.

These findings add to our understanding of telehealth and its impact on healthcare utilization, a growing area of research amid telehealth's enduring popularity.

Another study published last May showed that patients who participated in an initial visit through telehealth were as likely to need emergency department (ED) follow-up visits as those who received care in person, except for cases related to respiratory infection, bronchitis, and pharyngitis.

Researchers assessed data from 40 million privately insured patients younger than 65, collected from July to December 2020. They found that for 18 out of 21 conditions reviewed in the study, unplanned hospitalizations and follow-up ED visit rates were similar for in-person and telehealth visits within 14 days of the initial visit.