Telemedicine Reduced After COVID-19 Peak, Mental Health Video Visits on Rise

Jacqueline M. Ferguson, PhD

Credit: Stanford University

Despite telemedicine visits stabilizing around May 2021 and decreasing after the COVID-19 pandemic peak, mental health video visits continued to increase in the past year, a new study found.¹

“This [Veteran Affairs] study provides an updated timeline of the fluctuations in use of in-person care and telemedicine since the onset of the COVID-19 pandemic,” wrote investigators. “A new equilibrium has emerged in which telephone-based care has largely returned to prepandemic levels, whereas video based care accounts for 11% to 12% of outpatient care (2300% increase from a prepandemic level of 0.5%).”

During the beginning of the COVID-19 pandemic, many people turned to telemedicine for healthcare visits—even individuals on Medicare.² Before the pandemic, Medicare beneficiaries could not use the telehealth service unless access to in-person care was limited by location. This changed with the pandemic—during that time, the department of health and human services waived some of its telehealth restrictions for Medicare, making it easier for some individuals to get to their appointments.²

The study, led by Jacqueline M. Ferguson, PhD, from the Center for Innovation to Implementation at Veterans Affairs Palo Alto Health Care System in Menlo Park, California, sought to assess the format trends of clinical outpatient visits between January 1, 2019 and August 2023.¹ The team assessed outpatient visits that took place in person, by telephone, and by video before, during, and after the pandemic. Before the pandemic was March 11, 2020, during the pandemic was March 11, 2020 – May 10, 2023, and after the pandemic was marked by the end of the federal COVID-19 Public Health Emergency declaration on May 11, 2023.

Participants came from the US Department of Veterans Affairs healthcare system, and the investigators identified 277,348,286 clinical outpatient visits through the Veteran Affairs Corporate Data Warehouse. The database contained data from 9 million veterans enrolled in Veteran Affairs services and approximately 5.4 million used Veteran Affairs outpatient healthcare services in 2019.

The data included in the study was comprised of 91% males, 72% White participants, and 65% who lived in urban settings. Healthcare visits were categorized by care service (primary care, mental health, subspecialty care), and modality (in-person, mental health, and video).

The team observed Veteran Affairs had 1.14 million primary care, subspecialty, or mental health visits every week and 4.9 million visits every month. The number of visits began to decrease at the start of the pandemic and did not stabilize until March 2021.

“Notably, this stabilization occurred when vaccines were widely available—2 years before the end of the federal COVID-19 Public Health Emergency declaration,” wrote investigators.

In-person primary care and mental health services were replaced by telemedicine. As in-person visits decreased, telephone and video-based visits increased, with in-person visits reduced from 81% in February 2020 to 23% in May 2020.

However, telephone and video-based care began decreasing from a peak of 79.6% of care in April 2020 to 36.7% in April 2023. The percentage was mainly due to the decrease in telephone visits—not video visits—as the number of video visits remained close to the peak at levels 11% - 13%.

Investigators pointed out people continued to utilize video visits for mental health but use for primary care and specialty visits began to decline as the pandemic neared its end. By August 2023, 34.5% of mental health visits, 3.7% of subspeciality visits, and 3.5% of primary care visits occurred on video—and 20.3%, 34.8%, and 16.7%, respectively, accounted for telephone visits.

The investigators stated 55% of mental health care continues to be provided via telemedicine, which is likely because mental health services have adapted to virtual platforms. Moreover, they pointed out while primary care and subspeciality telemedicine are “often limited by the need for in-person evaluation,” including physical examinations, 10% of primary and subspecialty care has switched over to telemedicine.

“Although these nationwide trends can inform research and policy, they obscure disparities in access to and use of telemedicine that disproportionately affect older adults, individuals in rural regions, and patients from historically marginalized groups,” investigators wrote. “Future research should consider evaluating quality, safety, and health outcomes of telemedicine in this new equilibrium.”

^References

1. ^{Ferguson JM, Wray CM, Van Campen J, Zulman DM. A New Equilibrium for Telemedicine: Prevalence of In-Person, Video-Based, and Telephone-Based Care in the Veterans Health Administration, 2019-2023. Ann Intern Med. Published online January 23, 2024. doi:10.7326/M23-2644}
2. ^{Telehealth in the Pandemic—How Has It Changed Health Care Delivery in Medicaid and Medicare? U.S. Government Accountability Office. September 29, 2022. https://www.gao.gov/blog/telehealth-pandemic-how-has-it-changed-health-care-delivery-medicaid-and-medicare. Accessed January 23, 2024.}