Audio-Only Telehealth Still Prevalent at California Safety Net Clinics
According to an April 11 news release, a study found that audio-only telehealth visits for primary care and mental health services remain common at safety net clinics in California. The study was conducted by Santa Monica, Calif.-headquartered RAND Corporation, a nonprofit research organization. The study is published as a “Research Letter” in JAMA Network and is entitled, “Changes in In-Person, Audio-Only, and Video Visits in California’s Federally Qualified Health Centers, 2019-2022.”
Santa Monica, Calif.-headquartered RAND Corporation, a nonprofit research organization, study found that audio-only telehealth visits for primary care and mental health services remain popular at safety net clinics in California.
The release says that “Although audio-only visits have declined since their peak early in the pandemic, the study published in the Journal of the American Medical Association found that in August 2022 audio-only visits still accounted for one in five primary care visits and two in five behavioral health visits among people who received care at Federally Qualified Health Centers in California.”
“Researchers say the higher rates of audio-only telehealth in safety net settings raises questions about the quality of care and equity for low-income patients, since the effectiveness of audio-only telehealth has not been established,” the release adds.
Many payers began reimbursing safety net clinics for telehealth services through video or audio-only technology at the beginning of the pandemic. In the past, clinics did not receive payment for telehealth services delivered directly to patients.
Researchers at RAND looked at the experiences of 30 multisite Federally Qualified Health Centers in California that provide care for 1.3 million lower-income people. The majority of the clinics are in rural areas of the state. The study includes information about billable in-person and telehealth (video and audio-only) visits from February 2019 to August 2022.
The release adds that “The study found that that number of primary care visits increased by 8.5 percent from February 2020 to August 2022, while the number of total behavioral visits increased 23 percent during the same period. The increases are likely the result of being able to widely offer telehealth services, even as the clinics lost staff members.”
Further, “Researchers found that audio-only telehealth visits for primary care services peaked in April 2020, while audio-only visits for behavioral health peaked in March 2021.
“Within primary care, the decline in audio-only visits from the early pandemic peak appears to coincide with the return of in-person visits rather than growth in video visits.”
Regarding primary care, in-person visits increased from 30 percent in April 2020 to 71 percent in August 2022 and audio-only visits decreased from 67 percent to 21 percent, while video visits increased from 4 percent to 7 percent.
For behavioral health, in-person visits increased from 20 percent in April 2020 to 37 percent in August 2022 and audio0only visits decreased from 75 percent to 39 percent, while video visits increased from 8 to 23 percent.
“Researchers say that Federally Qualified Health Centers' continued use of audio-only telehealth may be a result of the clinics and their patients not having access to the technology needed for video telehealth. In addition, since California's Medicaid program (Medi-Cal) granted permanent payment parity for audio-only visits, there are no financial incentives for the clinics to limit audio-only visits,” the release notes.
Lori Uscher-Pines, lead author of the study and a senior policy researcher at RAND, was quoted in the release saying that “It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services. Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward.”
