Telehealth linked to fewer in-person follow-up visits

by Jeff Lagasse

Telehealth has been firmly established as a viable treatment methodology, and the COVID-19 pandemic highlighted many of its advantages, but a new Epic Research white paper has found one potential shortcoming: Telehealth visits are linked to fewer in-person follow-ups as compared to in-office visits.

Researchers examined more than 40,000 specialty and 32,000 primary care encounters from January 2022 to March 2023, excluding specialties with fewer than 300,000 encounters during the study period. Of the 24 specialties evaluated, Epic found that 16 specialties saw an in-person follow-up after an office visit more often than after a telehealth visit.


Mental health, physical medicine and rehabilitation, and pain medicine had at least a 20% higher follow-up rate after an office visit than a telehealth visit. Conversely, podiatry telehealth visits had an in-person follow-up rate 13% more than office visits.

Interestingly, telehealth use in 2022 and early 2023 was infrequent for most specialties, with only sleep medicine and mental health specialties conducting at least 20% of encounters using telehealth.

Follow-up rates for telehealth and office visits in primary care were within two percentage points of each other, with pediatrics and internal medicine slightly more likely to have follow-up after telehealth. Family medicine saw nearly equivalent follow-up rates between telehealth and office visits that have in-person follow-up within 90 days.

Expanding the analysis to include any type of follow-up – telehealth or in-person – showed greater rates of follow-up after office visits for most specialties. But all types of primary care have a slightly higher follow-up rate after telehealth when researchers include both telehealth and in-person visits in the next 90 days.

Authors said the findings suggest that telehealth can continue to play an important role in care delivery across specialties without requiring additional visits for many patients. 

Of note, there may be differences in the patient populations that seek care through telehealth and in-person visits, such as age, acuity of the condition and other potential confounders that may influence the likelihood of the follow-up care required.


In October 2022, after three months of relative stability, national telehealth utilization declined 3.7%. Looking at one specific metric, telehealth went from 5.4% of medical claim lines in September, to 5.2% in October, according to FAIR Health’s Monthly Telehealth Regional Tracker.

The decline in telehealth utilization was larger than the national average in the South (6.8%), Midwest (4.9%) and West (4.1 %), while there was an increase in utilization of 1.7% in the Northeast.

In order to help beneficiaries maintain access to care amid stay-at-home orders aimed at reducing COVID-19 related exposure, CMS used emergency waiver authorities enacted by Congress, as well as existing regulatory authorities, to implement policies expanding access to telehealth services during the pandemic.

These included waiving several statutory limitations, such as geographic restrictions, and allowing beneficiaries to receive telehealth in their home. 

The omnibus spending package that passed in December extended telehealth – and hospital-at-home programs – beyond the end of the public health emergency. The legislation extends waivers for both programs. Telehealth flexibilities are now in effect through the end of 2024.

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