Telehealth utilization trends vary across specialties

New research shows that telehealth use varied widely by specialty type after the peak of the COVID-19 pandemic, with telehealth utilization remaining high within mental healthcare and waning within cardiology.

Published in npj digital medicine, the study assessed telehealth utilization across various medical specialties as well as telehealth disparities. Telehealth utilization has undergone significant ups and downs in the last four years. According to Epic Research, telehealth use encompassed less than 1% of all visits in 2019, then jumped to 31.2% in the second quarter of 2020 before dropping to 5.8% in the third quarter of 2023.

However, disparities in telehealth use also became apparent over the course of the pandemic. Data shows that social determinants of health factors -- such as race, age, location, and primary language -- can affect telehealth access and utilization.

For the new study, researchers from the Northwestern University Feinberg School of Medicine performed a retrospective analysis of EHR data gathered from hospitals in Illinois. They studied telehealth use and no-shows -- patients who did not attend their appointments -- among 444,752 adult patients with 1.97 million outpatient visits between January 1, 2021, and July 1, 2022. The researchers termed this period the "sustained pandemic phase."

Telehealth accounted for 202,933 visits (10.28%), and 84,290 patients (4.27%) were no-shows.

During the sustained pandemic phase, the mental health, endocrinology, and genetics specialties displayed higher telehealth usage, ranging from 19.8% to 64.5% of total completed visits. Meanwhile, telehealth use in cardiology, dermatology, and obstetrics-gynecology specialties spiked in March and April 2020 but declined after.

The researchers also identified a resurging group of specialties, including primary care, pulmonology, and oncology, which displayed growing telehealth use during the sustained pandemic phase following an initial fall after May 2020.

Further, researchers found telehealth was associated with reduced no-show odds compared to in-person visits. Telehealth even reduced racial disparities in the likelihood of no-shows, with lower no-show odds among Hispanic and Black patients participating in telehealth visits compared to white patients receiving in-person care. Still, within telehealth, Black and Hispanic patients continued to have higher no-show odds than their white counterparts.

Additionally, the study shows that no-show odds varied by specialty. For instance, no-show odds were significantly higher within mental healthcare compared to primary care, and telehealth was not significantly associated with reducing these odds.

Researchers also observed telehealth-based racial disparities within mental healthcare compared to primary care. They found that telehealth was linked to significantly higher no-show odds for Black and Hispanic patients seeking mental health services, while white patients experienced lower no-show odds with telehealth.

"In summary, our study contributes to an understanding of telehealth's evolving role and the entrenched disparities in its use and no-shows during the sustained phase of the pandemic," the researchers concluded. "The findings provide a foundation for future research to inform nuanced policy decisions that promote equitable healthcare access across different patient groups and medical specialties as we move beyond the pandemic."

The study comes as Congress deliberates whether to extend pandemic-era regulatory flexibilities that expanded telehealth adoption and use.

These flexibilities include waivers that eliminated geographic restrictions on originating sites for telehealth services, allowed federally qualified health centers and rural health centers to continue providing telehealth services and lifted the initial in-person care requirements for those receiving mental healthcare through telehealth. Congress previously extended these waivers through the end of 2024.

Calls to make these flexibilities permanent have intensified. However, Congress appears to be considering another two-year extension instead. Earlier this year, the U.S. House Ways and Means Committee advanced a bill extending several pandemic-era waivers through Dec. 31, 2026.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.