Clinics serving low-income Americans favor audio-only telehealth

Keith A. Reynolds

Nearly all telehealth visits at clinics aimed at lower-income Americans were audio-only.

While the COVID-19 coronavirus pandemic has increased the use of telehealth services in primary care, yet lower-income Americans are still being denied equitable care.

According to a news release, a Rand Corporation study found that most telehealth appointments have been audio-only visits which could lead to insurers paying lower reimbursement rates.

The study looked at 500 clinics across California that maintained relatively stable visit volume and found that about half of the primary care visits from March to August 2020 were done via telehealth while prior to the pandemic there was minimal use of telehealth. Among these primary care visits 48.5 percent occurred by telephone, 3.4 percent via video, and 48.1 percent were in person, according to the study which was published in the latest issue of the Journal of the American Medical Association.

Before the onslaught of COVID-19, audio-only visits were excluded in many definitions of telehealth and was not often reimbursed by insurers or government programs. Many insurers and the Centers for Medicare & Medicaid Service (CMS) have signaled payments for these types of visits when the pandemic ends, the release says.

"While there are important concerns about the quality of audio-only visits, eliminating coverage for telephone visits could disproportionately affect underserved populations and threaten the ability of clinics to meet patient needs," Lori Uscher-Pines, the study's lead author and a senior policy researcher at RAND, says in the release.

The researchers found that, among the California clinics primary care visits only dropped by 6.5 percent during the studied period and telehealth use declined after an early peak in April when it accounted for 65.4 percent of visits, according to the release.

"Lower-income patients may face unique barriers to accessing video visits, while federally qualified health centers may lack resources to develop the necessary infrastructure to conduct video telehealth," Uscher-Pines says. "These are important considerations for policymakers if telehealth continues to be widely embraced in the future."