Telehealth Use Fell Nationally, in all 4 US Regions in April

July 10, 2023 - Following a rise in the prior month, the FAIR Health Monthly Telehealth Regional Tracker reported that telehealth use decreased across the board, nationally and in all four United States census regions, in April.

The FAIR Health tracker is a service that describes changes in telehealth usage on a monthly basis through the tracking of claim lines, procedure codes, and diagnostic categories. It represents a privately insured population that includes Medicare Advantage and excludes Medicare Fee-for-Service and Medicaid beneficiaries.

It has been over three years since the start of the COVID-19 pandemic. Throughout the public health emergency, overall telehealth use grew dramatically and remains widely used.

In April, however, the FAIR Health Monthly Telehealth Regional Tracker indicated a slight decline in telehealth use. This took place at the national level and in all US Census regions. Specifically, national telehealth use dropped 5.4 percent at the national level, from 5.6 percent of medical claim lines in March to 5.3 percent in April. This result contrasts with data gathered in March, which indicated a rise in national telehealth use of 1.8 percent.

Across US census regions, declines of 4.7 percent, 6.3 percent, 6.8 percent, and 6.4 percent took place in the Midwest, Northeast, South, and West, respectively.

Regarding diagnoses, mental health conditions were the most prevalent in April. These were the top-ranking telehealth diagnoses at the national level and in all regions. Mental health conditions rose from 67.4 percent of telehealth claim lines nationally in March 2023 to 68.4 percent in April.

Acute respiratory diseases and infections were second-place on the top telehealth diagnoses list. For this condition, however, the share of telehealth claim lines dropped from 3.2 percent in March to 2.7 percent in April. 

Other changes included developmental disorders and joint/soft tissue diseases switching places on the top telehealth diagnoses list at the national level, with the former rising to third place and the latter falling to fourth place.

Changes in national asynchronous telehealth activity also occurred in April, with mental health conditions swapping positions with urinary tract infections on the list of top five diagnoses via asynchronous telehealth. While claims for mental health conditions rose to third place, claims for urinary tract infections dropped to fourth.  

Hypertension was another condition that experienced changes per asynchronous telehealth claim lines. At the national level, hypertension's share of claim lines rose from 9.7 percent in March to 12.5 percent in April. In the West, it rose from second to first place on the top diagnoses via asynchronous telehealth list while also jumping from fourth to second place in the South. No changes took place nationally, in the Northeast, and in the Midwest, with asynchronous telehealth-enabled hypertension diagnoses remaining in second place nationally and in the Northeast, and first in the Midwest.

Sleep disorders also changed positions in the rankings on various asynchronous telehealth diagnoses lists. In the Northeast, this condition rose from fifth to fourth place. In the West, it rose from fourth to second place.

In the Midwest, Northeast, and West, diabetes mellitus also jumped in its rankings on top asynchronous telehealth diagnoses lists.

Overall, audio-only telehealth was not common in April. Its use declined in rural and urban areas nationally and in most US regions. In the West, however, its use rose in urban areas but dropped in rural areas.

Despite the overall decline in telehealth use in April, research indicates a high likelihood that it will not diminish entirely and that the healthcare industry supports this type of care.

Earlier this year, several healthcare groups requested that the Drug Enforcement Administration (DEA) make changes to its proposed rules surrounding virtual prescribing. This occurred after the DEA announced proposed rules in February that extended certain virtual prescribing flexibilities implemented during the COVID-19 pandemic while eliminating others. The proposal included ending flexibilities that allowed for virtual prescribing of some controlled substances, like Adderall, Oxycodone, and Vicodin, during the pandemic.

In response to this action, the healthcare industry wrote letters to the DEA, requesting the agency reconsider its proposal.

In May, the agency issued a temporary rule that extends COVID-era waivers for the remote prescribing of controlled substances via telehealth through November.