The University of Michigan Institute for Healthcare Policy & Innovation (IHPI) released a report last week detailing research on telehealth access, cost, and quality at Michigan Medicine clinics and hospitals. The report includes “snapshots” of data that show disparities in access, similar labor costs and productivity levels among video and in-person visits, and clinicians’ perspectives on telehealth.
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The report was compiled by IHPI’s Telehealth Research Incubator, a research development team, to “disseminate IHPI-member research on the role of telehealth in improving health care access, enhancing patient experience, and reducing costs.” It began in 2018 and has brought over 30 collaborators from all silos at University of Michigan’s schools of study.
The study was broken down into six sections: telehealth trends, telehealth and access, telehealth and costs, telehealth and quality, telehealth and the user experience, and speciality specific studies.
Chad Ellimoottil, M.D., director of the Telehealth Research Incubator, outlined the importance and significance of the study.
“The rapid pivot to virtual visits in March and April 2020, when health care organizations were limiting in-person care to the most essential interactions, was one of the most rapid and revolutionary shifts modern medicine has ever witnessed. Rapid access to data such as these can help decisionmakers at all levels make choices to make the best use of this option, but only if they listen to the voice of the patient and the frontline provider.”
The report found that patients who are African American, need an interpreter, use Medicaid as primary insurance, or live in a low broadband area were less likely to access video visits. For example, 10.2% of African Americans and 12.1% of Medicaid beneficiaries were less likely to access video visits compared to audio-only visits.
This image shows rates of video versus audio-only telehealth visits from among different categories of individuals.
The report also found that low broadband access — not just rurality — was one of the strongest predictors in the use of video visits for patients.
In the costs section, the report found in-person visits and video visits to have similar labor costs, but video visits did not necessarily increase productivity for clinicians. For example, surgeons spent more time with patients in video visits than they did in person. According to the study, this challenges clinician claims that telehealth can increase daily patient volumes and reduce marginal costs of telehealth visits.
Below is a chart from a survey conducted by Telehealth Research Incubator researchers for Michigan Medicine clinicians.
Of the 1,040 Michigan Medicine clinicians surveyed, 65% felt their productivity was the same or lower with the use of telehealth visits as compared to in-person visits.
The survey also asked about technological issues with video care. Of the clinicians surveyed, 73% felt their patients could navigate the technology without help, but 40% said technical issues hindered the start or continuation of the video visit.
The report also showed no difference in cancellation, no shows, and overall completion of visits with in-person and telehealth visits.
In the quality section, the report found primary care practices in Michigan who used telehealth more between June and Sept.of 2020 had marginally higher rates of emergency department visits for ambulatory care sensitive conditions (ACSCs) than practices with moderate to little telehealth use. The study says:
“However, our study period coincided with a period of unprecedented fluctuations in care utilization during the COVID-19 pandemic, which may have impacted the results.”
In the user experience section, the report found the majority of clinicians feel they could provide equal quality of care and rapport in video visits and in-person visits.
Below is a chart from the same survey of Michigan Medicine clinicians on their ability to provide quality care through telehealth.