Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic

Abstract

Importance: While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.

Objective: To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.

Design, setting, and participants: Insurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020).

Exposures: Telehealth implementation owing to the COVID-19 pandemic in March 2020.

Main outcomes and measures: (1) Conversion rate defined as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019. This outcome adjusts for a substantial decrease in outpatient care during the pandemic. (2) Weekly number of new patient telehealth visits divided by weekly number of total new patient visits.

Results: Among 4405 surgeons in the cohort, 2588 (58.8%) performed telehealth in any patient care context. Specifically for new patient visits, 1182 surgeons (26.8%) used telehealth. A total of 109 610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for patients who received care in-person. Prior to March 2020, less than 1% (8 of 173 939) of new patient visits were conducted through telehealth. Telehealth use peaked in April 2020 (week 14) and facilitated 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume. During period 2, a mean (SD) of 16.6% (12.0%) of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes). During period 3, 3.0% (2168 of 71 819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). Mean (SD) telehealth conversion rates varied by specialty with urology being the highest (14.3% [7.7%]).

Conclusions and relevance: Results from this study showed that telehealth use grew across all surgical specialties in Michigan in response to the COVID-19 pandemic. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic.

Figure 1.. Surgeon Telehealth Use in New Patient Visits by Surgical Specialty in 2020

The number of active surgeons during 2020 for each specialty are as follows: urology (n = 288), neurosurgery (n = 168), thoracic (n = 124), colorectal (n = 60), general surgery (n = 892), orthopedics (n = 698), obstetrics and gynecology (n = 1152), plastic surgery (n = 147), ophthalmology/ear, nose, and throat (ENT) (n = 876). The overall number of surgeons was 4405.

Figure 2.. Telehealth, In-Person, and Total Surgical New Patient Visits in 2020

Usage rates by week are calculated by total number of visits in 2020 divided by the mean weekly new patient visits in 2019 over the same period. Week 10 corresponds with the start of the COVID-19 pandemic in 2020 in the US. In 2019, there was a mean in period 1 of 6869, period 2 of 6769, and period 3 of 6610 total new patient surgical visits per week. In 2020, there was a mean of 6791 new patient surgical visits per week in preimplementation period 1. After telehealth implementation, period 2 (early pandemic) had 2907 and period 3 (late pandemic) had 5525 mean total new patient surgical visits per week.

Figure 3.. Mean Telehealth Conversion Rates After Telehealth Implementation in 2020 by Surgical Specialty

ENT indicates ear, nose, and throat.