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Cosmos Study

Most Primary Care Telehealth Visits Unlikely to Need In-Person Follow-Up

February 24, 2023
Dual-Team Study
Team A:Jackie Gerhart, MDAlex Piff
Team B:Kersten Bartelt, RNEric Barkley

Key Findings

  • More than 60% of the time, primary care telehealth visits did not have an in-person follow-up visit in the same specialty within 90 days.
  • Kids more frequently had an in-person office visit following a telehealth visit; however, more than half of the time (54%), kids did not have an in-person follow-up.
  • 55% of patients with Medicare or Medicaid insurance coverage did not have an in-person follow-up after a primary care telehealth visit.

Previously, we reported that patients who had a specialty telehealth appointment often did not require an in-person follow-up appointment within the next three months.1 We explored whether that same finding holds in the specialties of family medicine, general internal medicine, and pediatric primary care. We evaluated 18,636,522 primary care telehealth visits between March 1, 2020, and October 15, 2022, and looked at whether an in-person follow-up visit in the same primary care specialty occurred within the next three months.

We found that 61% of the time a patient did not have an in-person follow-up in the same specialty as their initial telehealth visit (Figure 1). General pediatrics was the most common primary care specialty to need in-person follow-up, but patients still had in-person follow-up less than half of the time.

Figure 1
In-Person Primary Care Follow-up Rates
In-Person Primary Care Follow-up Rates
Figure 1: Same-specialty in-person follow-up within 90 days after a telehealth visit, by primary care specialty. The “All Primary Care” line represents the cumulative rates for family medicine, general internal medicine, and pediatric primary care.

We also evaluated whether there were differences in the rate of in-person follow-up based on a patient’s insurance coverage. We found that patients covered by Medicaid and Medicare had the highest in-person follow-up rates. However, 55% of the time patients did not have an in-person follow-up visit, regardless of coverage.

Figure 2
In-Person Primary Care Follow-up Rates by Payer
In-Person Primary Care Follow-up Rates by Payer
Figure 2: Percentage of primary care telehealth visits with a same-specialty in-person follow-up visit in the next 90 days, by payer type.

While primary care shows a slightly lower rate of telehealth visits without an in-person follow-up compared to the specialties previously evaluated, 1 the 61% without a follow-up in primary care might be an underestimate. Primary care physicians treat a wide variety of conditions, so the subsequent in-person visit might not have been related to the reason for the telehealth visit. For example, a telehealth visit for an upper respiratory infection wouldn’t affect whether a patient has a normal wellness exam scheduled in the next three months, yet in our study that would be counted as having had in-person follow-up.

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 180 million patients from 190 Epic organizations including 1,123 hospitals and more than 22,500 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions.

References

  1. Gerhart J, Piff A, Bartelt K, Barkley E. Telehealth Visits Unlikely to Require In-Person Follow-Up Within 90 Days. Epic Research. https://www.epicresearch.org/articles/telehealth-visits-unlikely-to-require-in-person-follow-up-within-90-days. Accessed: February 7, 2023.