Telemedicine primary care visits could yield claims savings

October 20, 2023

Source: Reed, et al Annals of Internal Medicine October 17, 2023 LINK

Researchers at Kaiser Permanente of Northern California reviewed over 2.3 million primary care visits delivered to about 1.6 million patients from April to December, 2021 and compared treatment and follow-up of virtual and in-person visits. This time period included the Delta wave of COVID-19. About half (49.2%) of the index primary care visits were in-person, about a fifth (19.5%) were video, and about a third (31.3%) were telephonic. Their research was published this week in Annals of Internal Medicine.

The researchers adjusted the results for a host of potential confounding issues, including age and gender, previous illness, wealth, education level and internet connectivity of home zip code, and distance from PCP office. What they found was generally heartening. Those who had virtual visits got fewer imaging and laboratory tests, and also got fewer prescriptions. Of course, patients who had a virtual visit may also have a problem that was less severe than the in-person visits. Prescriptions for antibiotics did not differ substantially. Virtual visits were more likely to lead to in-person PCP visits within seven days, which raises the concern that some virtual visits are additive, rather than a replacement of in-person visits.

Another potential worry is that those who had telemedicine visits were more likely to be seen in an emergency department or hospitalized within 7 days. This could be that in-person clinicians were able to avoid an emergency department visit because they could perform a full physical examination or make an office intervention. Higher hospitalization rates could be the direct result of a lower threshold to send to the emergency department for an evaluation. These differences were statistically significant due to the large sample size, but they are very small.

Researchers did not assess patient satisfaction or effectiveness of care. Researchers focused on follow-up for only seven days. Results at Kaiser Permanente, a tightly integrated multi-specialty group which offered virtual visits before the pandemic, might not be applicable to other practices.

Implications for employers:

-       This study shows that there are potential savings from virtual visits (lower lab and imaging tests) within 7 days of the index visit, and the incremental number of follow up visits is small. This study does not answer the question of whether net costs are lower for patients who use virtual visits for primary care.

-       Clinicians did not prescribe antibiotics or other medications at a higher rate at virtual visits.

-       Employers can seek reporting on telephonic vs. video visits. Video visits are likely of more clinical value, but most virtual visits in this study were performed by phone with audio only.

-       One in twelve (7.6%) virtual visits was associated with an in-person PCP visit within seven days. This is where virtual visits through a medical group could have an advantage over visits provided by a virtual-only provider.

-       Virtual visits are likely here to stay, and we’ll want to see further studies that will include patient experience and clinical outcomes.

Monday: Why health care costs so much more in the US compared to other developed countries

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