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Researchers Express Concerns Over Safety Net Clinics’ Use of Audio-Only Telehealth
Since the onset of the COVID-19 pandemic, telehealth has been championed as a method of expanding access to behavioral healthcare services, particularly for underserved communities.
New research from the RAND Corporation, however, calls into question the effectiveness and equity of audio-only behavioral healthcare treatment options that remain a common modality especially for Federally Qualified Health Centers (FQHCs).
While their use for behavioral healthcare have declined since their peak in the first year of the pandemic, audio-only visits still accounted for nearly 40% of behavioral healthcare services among people who received care from FQHCs in California as of August 2022, according to RAND. Study findings were published this month in the Journal of the American Medical Association.
“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,” study lead author Lori Uscher-Pines, a RAND senior policy researcher, said in a news release. “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.”
For its study, RAND reviewed data from 30 multisite FQHCs in California—many of which are in rural areas—that provide care for about 1.3 million lower-income individuals. The study included information about billable in-person and telehealth (video and audio-only) visits from February 2019 (pre-pandemic) to August 2022. After rarely covering telehealth-based services directly delivered to patients, payers began reimbursing safety net clinics for audio- and video-based telehealth services at the start of the pandemic.
Behavioral health-related visits increased by 23% during the study period, peaking in March 2021, thanks in large part to the proliferation of telehealth-based services, which made up for workforce shortages as clinics lost staff members, RAND researchers said.
Providers’ reliance on telehealth began to wane as the pandemic wore on, however, as the proportion of in-person behavioral health visits increased from 20% in April 2020 to 37% by August 2022. Audio-only visits decreased from 74% of total behavioral health-related visits to 39% over the same period. For comparison, primary care saw just 21% of its visits conducted over audio-only telehealth platforms by August 2022.
RAND researchers suggest that FQHCs’ continued use of audio-only telehealth could be the result of clinics and their patients not having access to technology necessary for video-based telehealth. Furthermore, because California’s Medicaid program granted permanent payment parity for audio-only visits, clinics do not have financial incentives to limit their use of audio-only services.
That is a concern, RAND researchers said, because the effectiveness of audio-only telehealth services has not been established.
“More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings,” Uscher-Pines said.
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