Patients Used Telehealth as a Substitute for Post-Discharge Visits

The number of outpatient visits after hospital discharges remained stable during the COVID-19 pandemic but telehealth use for these visits increased, suggesting that telehealth was a substitute for in-person care rather than an addition, a study published in JAMA Health Forum revealed.

There was a significant uptick in telehealth use at the start of the pandemic. Since then, patients and providers alike have expressed their satisfaction with virtual care.

As policymakers consider the future of telehealth, they must weigh the pros and cons of virtual care. Understanding if telehealth increases access to care and if it substitutes for or adds to in-person care are two key areas of consideration.

University of Pennsylvania researchers analyzed hospital discharges and subsequent outpatient visits from commercially insured patients to track telehealth use during the pandemic.

Using claims data from FAIR Health between January 2019 and December 2020, the researchers looked at 1.6 million hospital discharges and the outpatient visits that occurred within 30 days after a discharge.

The overall number of post-discharge outpatient visits stayed the same for the most part. Pre-pandemic, 72 percent of hospital discharges had an accompanying outpatient visit. That number increased slightly to 75 percent in May 2020 but declined soon after to pre-pandemic levels.

Post-discharge in-person visits decreased, going from 72 percent in April 2019 to 55 percent in April 2020, the analysis revealed. The mean number of in-person outpatient visits per discharge decreased by 0.6, going from 2.94 in 2019 to 2.35 in 2020.

Meanwhile, telehealth visits increased from zero percent in April 2019 to 46 percent in April 2020. The mean number of telehealth visits per discharge went from 0.02 in 2019 to 0.7 in 2020, increasing by 0.7 and making up for the decrease in the rate of in-person visits.

Before the COVID-19 pandemic, telehealth was used more as an addition to in-person care, researchers noted. But the study findings suggest that patients used telehealth in place of in-person care once the pandemic hit.

Many patients deferred discretionary care during the pandemic to avoid in-person contact. But it was essential to find an alternate delivery method for non-discretionary care.

Post-discharge follow-up visits are likely to be considered non-discretionary, as they can be crucial to a patient’s recovery. Telehealth visits offered a convenient option for patients who were recovering from hospitalization and wanted to reduce in-person contact and exposure to the coronavirus.

The results show that telehealth increased access to post-discharge care and was used in a substitutive manner rather than an additive one.

“As state and federal emergency waivers expire, policymakers will need to decide which telemedicine services deserve ongoing coverage, and at what level,” researchers wrote.

Some healthcare stakeholders are concerned that reimbursing telehealth at the same rate as in-person care will lead to overutilization. The study results showed that that is not necessarily true, at least for outpatient visits following hospital discharges. The rate of post-discharge telehealth visits has remained steady since June 2020, with 30 percent of patients continuing to use the service for the visits.

A separate study from Massachusetts General Hospital and Harvard Medical School revealed that telehealth was substitutive rather than additive for ambulatory care as well.