Telehealth explosion points to need for more research on quality of care provided

June 18, 2020 02:57 PM


As telehealth adoption takes off in response to the COVID-19 pandemic, quality analysts and health systems claim much is still unknown about the quality of these virtual visits.

Telehealth is often touted for its ability to improve access to care and lower healthcare spending, but those assertions haven’t been widely or rigorously tested, according to experts. Data collection from telehealth visits has been low until recently with minimal motivation to research due to limited payer reimbursement. The National Quality Forum hasn’t endorsed a single telehealth-specific measure.

“There is a lot of popular dialogue about the possibilities of telehealth and what the future of telehealth looks like but very little of that dialogue is based on outcomes and data,” NQF’s CEO Dr. Shantanu Agrawal said. “There are elements of quality and value that we really should be working on to understand in telehealth.”

There’s growing advocacy that the reimbursement flexibilities made in response to COVID-19 should stay, and health systems are interested in researching how the platform holds up in terms of quality.

“There is a lot of opportunity for growth and development when you look at the literature around patient safety and effectiveness of care in telemedicine,” said Jeffrey Rakover, senior research associate at the Institute for Healthcare Improvement. Health systems could help in that endeavor as they collect data from visits.

UCSF Health in California is assessing some aspects of quality with all its new telehealth data as it sees a surge in usage during the pandemic. While UCSF has had a telehealth platform since 2015, adoption has been steady, said Linda Branagan, director of telehealth programs. In February, UCSF conducted about 3,600 telehealth visits. In April, that figure rose to more than 50,000.

With the data from the encounters, Branagan said the system is currently analyzing the demographics of those who have had virtual visits, looking at age, race, illness and ZIP code. She said the hope is to understand if telehealth is improving access to those who typically wouldn’t receive services.

“We care that the platform is equitable,” Branagan said. “We want to make sure it’s something that people can utilize with or without a smartphone, with or without unlimited minutes.”

Similarly, telehealth leaders at Geisinger Health in Danville, Pa., would like to better understand what conditions work best for telehealth. Currently, there isn’t much literature that compares the outcomes between a virtual visit and an in-person visit to truly know which is better for the patient, said David Fletcher, Geisinger’s associate vice president for telehealth services.

His team is interested in comparing emergency department utilization, readmission rates and overall healthcare usage among patients with the same conditions who had telehealth and an office visit.

“Everyone has wanted to do this kind of study,” Fletcher said, but there wasn’t enough data until now.

Geisinger and other providers interested in this research will face a challenge making sure their data is scientifically valid, said Alex Anderson, a research associate at IHI.

Health systems will need to account for compounding factors like the different characteristics between patients who receive telehealth visits and those who see their doctors in-person.

“It’s very difficult to make those comparisons. My hope is as time goes by, health systems will have more comfort and expertise in doing that,” Anderson said.

Health systems may also be hesitant to fund telehealth research as they don’t know whether Medicare will continue giving them reimbursement flexibility after the public health crisis passes, Anderson said.

Fletcher at Geisinger said while leadership would feel more comfortable making investments in telehealth research if there was more reimbursement certainty, “the general perception is that at least the commercial payers will continue to pay for in-home telemedicine in some fashion and so we are making plans under that assumption.”

As the industry gathers more data and understanding of the telehealth space, Agrawal said measures specific to the platform are likely going to follow. For instance, developing patient-reported outcomes measures specific to a telehealth interaction would be helpful. Right now, systems typically use patient experience surveys similar to what a patient receives after an in-person visit.

“The data and claims that are being generated right now serve as a good foundation” for future measure development in telehealth, Agrawal said.