Predictors of Audio-Only Versus Video Telehealth Visits During the COVID-19 Pandemic

Abstract

Background: Most health insurance organizations reimbursed both video and audio-only (i.e., phone) visits during the COVID-19 pandemic, but may discontinue phone visit coverage after the pandemic. The impact of discontinuing phone visit coverage on various patient subgroups is uncertain.

Objective: Identify patient subgroups that are more probable to access telehealth through phone versus video.

Design: Retrospective cohort.

Patients: All patients at a U.S. academic medical center who had an outpatient visit that was eligible for telehealth from April through June 2020.

Main measures: The marginal and cumulative effect of patient demographic, socioeconomic, and geographic characteristics on the probability of using video versus phone visits.

Key results: A total of 104,204 patients had at least one telehealth visit and 45.4% received care through phone visits only. Patient characteristics associated with lower probability of using video visits included age (average marginal effect [AME] -6.9% for every 10 years of age increase, 95%CI -7.8, -4.5), African-American (AME -10.2%, 95%CI -11.4, -7.6), need an interpreter (AME -19.3%, 95%CI -21.8, -14.4), Medicaid as primary insurance (AME -12.1%, 95%CI -13.7, -9.0), and live in a zip code with low broadband access (AME -7.2%, 95%CI -8.1, -4.8). Most patients had more than one factor which further reduced their probability of using video visits.

Conclusions: Patients who are older, are African-American, require an interpreter, use Medicaid, and live in areas with low broadband access are less likely to use video visits as compared to phone. Post-pandemic policies that eliminate insurance coverage for phone visits may decrease telehealth access for patients who have one or more of these characteristics.

Keywords: COVID-19; telehealth; video visits.

Figure 1.

Phone visit-only users vs. video visit users by age group. Source: Michigan Medicine institutional data April 1, 2020, through June 30, 2020.

Figure 2.

Phone visit-only users vs. video visit users by patient demographics. Source: Michigan Medicine institutional data April 1, 2020, through June 30, 2020.

Figure 3.

Phone visit-only users vs. video visit users by geographic variables. Sources: Michigan Medicine institutional data April 1, 2020, through June 30, 2020. American Community Survey 2018 5-years estimates. Digital Divide Index, Purdue University Center for Regional Development.

Figure 4.

Average marginal effects of patient and geographic variables on the probability of being a video visit user, adjusted for other patient and geographic factors. Please refer to Appendix Table 2 for the values corresponding to the quartiles of geographic variables. Error bars show the 95% confidence interval for the estimated average marginal effects. Source: Michigan Medicine institutional data April 1, 2020, through June 30, 2020. American Community Survey 2018 5-years estimates.

Figure 5.

Illustrative examples of the cumulative effect of more than one factor on the predicted probability of video visit use among telehealth users. Source: Michigan Medicine institutional data April 1, 2020, through June 30, 2020.