Zocdoc Founder and CEO Oliver Kharraz

Telehealth

Telehealth Rarely Requires In-Person Follow-Ups

Epic Research tied a nice ribbon on the end of 2022 with a study suggesting that telehealth is an efficient use of resources for most specialties, rarely requiring an in-person follow-up within 90 days.

The research appears to indicate that telehealth isn’t usually duplicative of in-person visits, adding weight to the argument that regulators should view it as an alternative, rather than an additional encounter.

After examining over 35M telehealth visits conducted between March 2020 and May 2022, Epic Research found a pretty wide spread between specialties for both the number of telehealth visits and in-person follow-up percentages.

• Here’s a look at the full breakdown.

The main finding was that high follow-up rates were present only in specialties that require regular in-person visits for hands-on care, such as obstetrics and surgery. 

• Mental health and psychiatry had the highest telehealth utilization and some of the lowest need for in-person follow-up. No surprises there.

• Only 15% of telemental health visits needed an in-person follow-up within the next three months.

• On the opposite end of the spectrum, obstetrics (92%), fertility (54%), and geriatrics (50%) had the highest need for in-person follow-ups.

• In specialties that could be consultations (e.g. genetics, nutrition), the researchers stated that telehealth might even replace the need for in-person visits.

The Takeaway

While the numbers certainly look good for telehealth at first glance, the pandemic itself might be doing them a lot of favors.

Many medical offices closed at the beginning of the study period, and most didn’t reopen to in-person appointments for several months. Plenty of patients also remain wary of in-person visits due to the risk of virus exposure. Both factors probably skewed the in-person follow-ups to a lower range.

Those details aside, Epic Research gave a great overview of in-person follow-up needs by specialty, and the more data we can wrap around telehealth’s impact the better.

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The Wire

• Two Year Telehealth Extension: With just two days to spare before the year-end deadline, President Biden signed a massive $1.7 trillion omnibus spending package that included plenty of implications for US healthcare. What does $1.7T get you these days? It extends pandemic-era telehealth flexibilities for another two years, puts a two year delay on in-person screening requirements for Medicare telemental health visits, and allows providers to continue offering hospital-at-home programs. It also keeps the lights on in US government buildings until… September.

• Komodo Scores $200M: Komodo Health raised $200M in structured equity funding to continue scaling its analytics tools while buckling down for choppy macroeconomic conditions. The funding announcement was joined by a new restructuring plan and a 9% workforce reduction, and it might be telling that the company only mentioned its previous valuation of $3.3B in the latest release. 

• Hospital Ownership Data Tool: In its latest effort to increase healthcare transparency, the HHS created a public tool that makes ownership data available for more than 7k Medicare-certified US hospitals. The searchable database will be updated monthly to outline hospital ownership changes, allowing users to see whether an organization is a direct or indirect owner and filter by classification types such as investment firm, holding company, or staffing firm. 

• Healthcare Typing Skills: A new study in BMJ revealed disparities in healthcare worker typing proficiency between age groups and medical specialties. Researchers tested 2.6k hospital employees in the Netherlands using a Santa themed typing test, finding that while the overall average typing speed was 60 words per minute, typing speed decreased significantly with every decade of age. Among specialties, internal medicine had the highest typing speed (64wpm) and medicinal microbiology had the slowest (50wpm). 

• Brightside Health Adds Crisis Care: Brightside Health introduced its new Crisis Care program to serve individuals who are experiencing acute suicidal thoughts and behaviors. The 4-12 week program is staffed by a group of CAMS-trained clinicians and includes 1:1 weekly video sessions, online check-ins, and anytime messaging / call support. It also employs a collaborative approach with documented in-session assessments, treatment planning, and safety plans.

• UMass Memorial Virtual Sitters: UMass Memorial Health is expanding its RPM virtual sitter program after a successful pilot that utilized Caregility’s telehealth carts and iObserver platform. The virtual sitter program allows a remote team to monitor up to 12 patients per screen with two-way audio and video support, and has logged over 100k interventions (patient interactions, bedside alerts, etc.) in its first year of operation.

• Mobile Intervention Effectiveness: Research in npj digital medicine found that guided internet and mobile-based interventions (IMIs) for depression and anxiety have a high probability of being cost-effective (≤ £30k per quality-adjusted life year gained). Analysis of 36 economic evaluations revealed that non-guided IMIs for anxiety and depression also appear to be cost-effective, although interventions for OCD and other conditions are less likely to be economically viable. 

• physIQ’s Remote Cardiopulmonary Test: physIQ developed a new way to estimate maximum oxygen utilization with wearables, providing clinicians with 24 hours of continuous vital signs and activity data. Unlike the in-clinic cardiopulmonary exercise test (the current gold standard) and the 6-minute walk test, physIQ’s eVO2Max is used in patient homes and requires no special protocol. The patient simply wears a tiny biosensor for a few days and wirelessly transmits the data to physIQ.

• Commons Clinic Seed Round: Commons Clinic raised $11M in seed funding to grow its specialty care model that helps patients avoid hospital visits for certain conditions, starting with MSK issues. Commons is quickly expanding its list of local practice acquisitions and adding partnerships with in-person facilities to supplement its virtual physical therapy programs, with the aim of building an ambulatory health system in several major markets over the next decade.

• UNC Integrative Medicine Goes Hybrid: UNC Health System is expanding its Integrative and Lifestyle Medicine Clinic to allow cancer patients to conduct holistic care visits either in-person or via telemedicine. The clinic supplements traditional cancer treatments with wide-ranging services such as mind-body practices, nutrition, and lifestyle strategies.

• Digital Intervention to Control Hypertension: PCPs guided by a web-based platform helped patients achieve better blood pressure control over a 12-month period than PCP’s without the assistance. In the Chinese study, over 4k patients with hypertension received either usual care or a “multicomponent intervention” (web-based platform consisting of health education, lifestyle modification, and follow-up management plans). The intervention group had a much greater improvement in the proportion of patients with controlled BP at 12 months than the control group (24.6 percentage points vs. 7.7 percentage points).

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