Minority, Rural Urology Patients More Likely to Use Audio-Only Telehealth

Nearly half of all telehealth visits at Michigan Medicine's department of urology were audio-only, indicating that care access may be hindered if audio-only options aren't available, according to a new study.

For the study, published in the journal Urological Practice, researchers retrospectively reviewed patients seeking outpatient urological care from April 1 to June 30, 2020. They examined the use of audio-only versus video-based telehealth, as well as the patient characteristics associated with each modality.

In total, 4,744 patients had a urological telehealth visit during the study period. Of these, 44 percent participated in an audio-only telehealth visit.

A wide range of demographic factors — age, ethnicity, location, type of insurance, and broadband Internet access — impacted the type of telehealth modality urological patients chose.

Patients who were older than 65 years, Black and American Indian/Alaska Native, and needed an interpreter were more likely to use audio-only telehealth, according to the study. In addition, patients on Medicaid and living in rural areas or areas with limited broadband access were more likely to select an audio-only option for virtual urological care.

"Our findings suggest that audio encounters may be an important medium for certain patient populations to connect with their physicians during the COVID-19 public health emergency and beyond," said Chad Ellimoottil, MD, senior author of the study and assistant professor of urology at the University of Michigan Medical School, in an accompanying press release.

"Those that chose a phone call likely did so because they did not have the capability to perform a video visit," he added.

This research bolsters previous studies that also show that older patients and those who are Black, need an interpreter, or live in rural areas are more likely to use audio-only telehealth.

Further, research shows that low-resource settings, like federally qualified health centers and community health centers serving disadvantaged populations, relied heavily on audio-only telehealth during the COVID-19 pandemic.

Experts also believe that data on audio-only telehealth use may be hampered by inaccuracies and biases, due to which the actual use of audio-only options may be even higher than current data indicates.

The uptick in audio-only telehealth use during the pandemic was made possible by regulatory flexibilities that enabled Medicare and other payers to reimburse audio-only visits at the same rate as video-based telehealth visits. But these flexibilities are tied to the COVID-19 public health emergency declaration, which ends Oct. 13.

Federal officials have acknowledged the health equity benefits provided by audio-only telehealth. At the inaugural National Telehealth Conference hosted by the Department of Health and Human Resources in May, officials from the Substance Abuse and Mental Health Services Administration and Indian Health Service noted how crucial audio-only telehealth options have been to ensure continued access to care, especially behavioral healthcare.

Despite this acknowledgment, the Centers for Medicare and Medicaid Services said it plans to discontinue reimbursement for audio-only care modalities in its proposed 2023 Medicare Physician Fee Schedule.

But policymakers may be seeking to prevent this by making audio-only reimbursement permanent. Last year, House representatives introduced the Permanency for Audio-Only Telehealth Act, which would establish coverage for providers who connect with patients using phone or non-video telehealth platforms.