Audio-only telehealth visits popular at safety net clinics, study found

Turn up the volume (and turn off your video). The use of audio-only telehealth appointments for primary care and mental health services has declined since the onset of the Covid-19 pandemic, but has remained popular at safety net clinics in California, a new study from nonprofit research organization Rand Corporation found.

One-fifth of telehealth primary care visits and two-fifths of behavioral health appointments were audio only as of August 2022, according to the study, which analyzed billable in-person and telehealth appointments at 30 federally qualified health centers (FQHC) in California between  February 2019 and August 2022.

“It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services,” Lori Uscher-Pines, lead author of the study and a senior policy researcher at Rand, said in a statement. “Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward.”

Audio-only primary care visits peaked in April 2020, compared to March 2021 for audio-only behavioral health appointments, the study found. These types of visits may have decreased because of the return of in-person appointments, rather than an increase in video visits.

The study comes as Congress debates whether some changes to telehealth rules, which were relaxed during the pandemic, will be made permanent. The relaxed rules sunset at the end of 2024.

At the beginning of the pandemic, the Centers for Medicare and Medicaid Services allowed providers to receive reimbursements for both audio and video telehealth appointments at the same rate as in-person visits. Before then, “FQHCs rarely received reimbursement for telehealth services,” according to the study.

California’s Medicaid program, Medi-Cal, granted FQHCs permanent payment parity for audio-only appointments in 2022, meaning “there are no financial incentives for the clinics to limit audio-only visits,” according to a statement from Rand.

“More research is needed to determine the effectiveness of audio-only visits,” Uscher-Pines noted.

Some lawmakers are advocating for increased telehealth flexibility. Last October, House representatives from New Hampshire and Massachusetts said audio-only appointments to prescribe buprenorphine for opioid use disorder may help reduce overdose deaths.