Most Telehealth Visits Do Not Require In-Person Follow-Up Visits Within 90 Days

By Christopher Cheney

In a new study that looked at more than 30 specialties, most patients who had a specialty telehealth visit did not require an in-person follow-up visit in that specialty over the next 90 days.

Since the beginning of the coronavirus pandemic, telehealth visits have increased dramatically. The millions of telehealth visits that have been conducted since the beginning of the pandemic are an opportunity for researchers to assess the utilization of telemedicine.

The new study, which was conducted by Epic Research, examined more than 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022. The research includes several key findings:

  • The two specialties that showed the fewest in-person follow-up visits in the 90 days after a telehealth visit were genetics (4% of telehealth visits) and nutrition (10% of telehealth visits)
    In specialties that often involve consultations such as genetics and nutrition, telehealth visits could replace the need for in-person visits
  • The two specialties that showed the most in-person follow-up visits in the 90 days after a telehealth visit were obstetrics (92% of telehealth visits) and fertility (54% of telehealth visits)
  • For specialties that showed relatively high numbers of in-person follow-up visits, the in-person visits were likely related to needing additional care rather than duplicative care
  • Mental health and psychiatry had the highest volume of telehealth utilization as well as one of the lowest numbers of in-person follow-up visits in the 90 days after a telehealth visit (15% of telehealth visits)

“These findings suggest that, for many specialties, telehealth visits are typically an efficient use of resources and are unlikely to require in-person follow-up care. If telehealth is not duplicative of in-person visits for those specialties, it can be an effective tool to help expand access to care,” the study’s co-authors wrote.

Interpreting the data

The lead author of the study, Jackie Gerhardt, MD, vice president of clinical informatics at Epic, told HealthLeaders that the relatively low numbers of in-person follow-up visits after a telehealth visit is significant.

“We specifically organized the study to look at what happened in the three months following a telehealth visit to find out whether or not someone needed an in-person visit within that three months. Our reasoning was that if you need a follow-up visit in that three months, it was likely that the visit was for the same condition. For example, you might have an orthopedic telehealth visit to talk about hip pain, and if you got the right recommendations that you needed, you probably would not need a follow-up visit in-person within orthopedics. So, we concluded that in specialties that did not need follow-up in-person, it was likely that the telehealth visit was able to stand on its own.”

Nutrition and genetics are examples of where telehealth visits could replace in-person visits, she said. “If you are asking for advice on nutrition or reviewing your genetic history, both of those can be transactional such that you get information that you need from a single consult, and it does not necessarily require a physical exam. The ability to do that during a telemedicine visit is very similar to information you would be gathering in-person. So, it could increase access and potentially improve the way that people can get care because they do not have to travel to a clinic and can more readily access their provider.”

Telehealth visits are an effective tool to help expand access to care, Gerhardt said. “Telehealth visits are part of our general advancement in healthcare toward being consumer-centric and patient-centric. Different organizations structure telemedicine in different ways; but in some cases, instead of having to stick to the 8-to-5, Monday-through-Friday services of in-person care, you can get more access in terms of the number of days and time slots through telehealth as well as get a visit more quickly than you can get an in-person visit.”

The study shows that telehealth visits can supplement or replace many in-person visits, she said. “Telehealth visits will never replace all in-person visits; but for specific specialties and specific types of visits, telehealth can serve as an adjunct or a replacement.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.