Telehealth Use Declines Across Primary Care Specialties

April 06, 2023 - Following a spike in telehealth use in 2020, usage dropped by over 30 percent across various primary care specialties in 2021 and 2022, according to data released by FAIR Health.

In a report released last month, FAIR Health used information from its database of private healthcare claims, as well as other sources, such as US census data and National Plan and Provider Enumeration System (NPPES) data, to analyze primary care trends in the US.

The report also includes an analysis of telehealth utilization trends in primary care, conducted using the Centers for Medicare & Medicaid Services (CMS) place of service codes for telehealth, telehealth-only CPT codes, or telehealth modifiers.

The report shows that telehealth use increased across various primary care specialties studied from 2019 to 2020.

Physician assistants represented the most significant increase, with a jump of almost 20,000 percent in patients treated via telehealth. Nurse practitioners followed physician assistants, with an increase of nearly 9,000 percent, and pediatricians came third, with an increase of over 6,000 percent.

"Temporary suspensions of practice agreement and supervision requirements allowed many nurse practitioners and physician assistants to engage in full practice, which could account for nonphysician providers showing the largest increases," the report states.

Family medicine and internal medicine physicians were associated with smaller increases in patients treated via telehealth, with percentage changes of about 1,100 percent and 2,100 percent, respectively.

But, in the two years following 2020, these figures dropped considerably.

Between 2020 and 2021, the percentage of patients seen via telehealth dropped by 36 percent each among physician assistants, nurse practitioners, and internal medicine physicians. That figure declined by 35 percent among pediatricians and 32 percent among family medicine physicians.

Telehealth utilization further decreased across primary care specialties from 2021 to 2022, though the declines were smaller for most. The percentage of patients treated via telehealth decreased by 9 percent for nurse practitioners and internal medicine physicians, while it dropped by 7 percent for family medicine physicians and 4 percent for physician assistants.

In contrast, the percentage of patients seen via telehealth decreased by another 35 percent among pediatricians from 2021 to 2022.

"Potential reasons for the continued decline in pediatric telehealth include barriers related to broadband connectivity, digital literacy, device access and interpretation services," the report states. "Additionally, families may prefer in-person care for children, especially for initial visits."

Despite the rise and fall of telehealth utilization across primary care, patients have expressed satisfaction with receiving these services virtually.

Survey results released by Elevance Health last November showed that 79 percent of more than 5,000 US adults believe virtual primary care allowed them to take charge of their health, and 94 percent were satisfied with their experience.

Further, convenience and accessibility were the top factors Americans cited when asked what appealed to them about virtual primary care.

Recent research also indicates that most primary care-related telehealth visits did not require an in-person follow-up visit. Conducted by Epic Research, the study involved a review of 18.6 million telehealth visits for primary care between March 1, 2020, and Oct. 15, 2022. The data was gathered from Cosmos, a HIPAA-defined limited dataset of more than 180 million patients from 190 healthcare organizations using the Epic EHR.

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.

But, of the specialties, pediatric primary care visits were the most likely to require an in-person visit after a telehealth visit, with 46 percent of these resulting in an in-person follow-up.