Most Virtual Primary Care Visits Do Not Require In-Person Follow-Ups

March 02, 2023 - A recent study conducted by Epic Research found that, more often than not, primary care-related telehealth visits did not result in the need for an in-person follow-up visit, indicating the reliability and efficacy of virtual care. 

Following the rapid uptake of telehealth services during the COVID-19 pandemic, concerns emerged regarding the safety and efficacy of telehealth alone and whether these types of visits would require in-person care.

This study, however, found that primary care visits that took place through telehealth often did not need an in-person follow-up visit within three months.

To determine this, researchers reviewed 18.6 million telehealth visits for primary care between March 1, 2020, and Oct. 15, 2022. The data was gathered from Cosmos, a HIPAA-defined limited dataset of more than 180 million patients from 190 healthcare organizations using the Epic EHR across all 50 states and Lebanon.

The telehealth visits included family medicine, general internal medicine, and pediatric primary care. Using this data, the researchers evaluated whether in-person follow-up visits occurred within 90 days of the telehealth visit in the same primary care specialty. As a secondary evaluation, they also aimed to determine whether a patient's insurance coverage correlated with in-person follow-up care.

The researchers found that 61 percent of primary care telehealth visits did not require an in-person follow-up within three months in the same primary care specialty. But they found that pediatric primary care visits were the most likely to require an in-person visit following a telehealth visit, with 46 percent of visits resulting in an in-person follow-up.

Virtual internal medicine and family medicine appointments required in-person follow-up visits 37 percent and 40 percent of the time, respectively.

On reviewing data related to insurance coverage, researchers found that 55 percent of both Medicare and Medicaid beneficiaries did not participate in an in-person follow-up after a telehealth visit for primary care. Meanwhile, 24 percent of self-pay patients participated in in-person follow-up visits following telehealth.

Prior research has attempted to determine the link between telehealth use and follow-up care.

A study published in April 2022 found that using telehealth to treat acute conditions was more likely to lead to follow-up visits compared to the care delivered in person.

Researchers reached this conclusion after reviewing data from 40 million patients and their activity between 2019 and 2020, acknowledging that the COVID-19 pandemic was linked to an increase in telehealth use between these two years.

After reviewing follow-up activity within two weeks of the initial visit, researchers noted that acute care patients who participated in an initial visit through telehealth were more likely to receive follow-up care. For example, 23.3 percent of first-encounter appointments for acute bronchitis occurred virtually. The odds ratio of a follow-up encounter was 1.23, higher than the odds ratio of 1 for those who participated in an in-person visit.

But, other research published last May found that emergency department follow-up rates were comparable after in-person and virtual care.

After reviewing data from 40 million privately insured patients and assessing 21 conditions, they found that unplanned hospitalizations and follow-up emergency department visit rates were similar for both care delivery methods for 18 conditions.