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Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic has dramatically altered patterns of health care delivery in the US. In the context of declining in-person outpatient visits, many clinicians began using telemedicine for the first time, spurred in part by regulatory changes that expanded public and private insurer reimbursement for a wider range of telemedicine services.1,2 To understand how telemedicine compensated for declining outpatient volume and geographic variation in changing patterns of outpatient care, we examined telemedicine and in-person outpatient visits in 2020 among a national sample of 16.7 million individuals with commercial or Medicare Advantage insurance.

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Article Information

Accepted for Publication: August 31, 2020.

Published Online: November 16, 2020. doi:10.1001/jamainternmed.2020.5928

Corresponding Author: Michael L. Barnett, MD, MS, Department of Health Care Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Kresge 411, Boston, MA 02115 (mbarnett@hsph.harvard.edu).

Author Contributions: Dr Patel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel, Mehrotra, Barnett.

Acquisition, analysis, or interpretation of data: Patel, Huskamp, Uscher-Pines, Ganguli, Barnett.

Drafting of the manuscript: Patel.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Patel, Barnett.

Obtained funding: Mehrotra, Huskamp, Uscher-Pines.

Administrative, technical, or material support: Patel.

Supervision: Mehrotra, Uscher-Pines, Barnett.

Conflict of Interest Disclosures: Dr Mehrotra reported grants from the National Institutes of Health during the conduct of the study. Dr Huskamp reported grants from the National Institute of Mental Health during the conduct of the study. Dr Ganguli reported personal fees from Haven and personal fees from Blue Cross Blue Shield Massachusetts outside the submitted work. No other disclosures were reported.

Funding/Support: This project was supported by the National Institute on Aging of the National Institutes of Health (K23 AG058806-01) and the National Institute of Mental Health (R01 MH112829, T32MH019733). We thank Rebecca Shyu for contributing to data analysis, visualization, and manuscript preparation efforts.

Role of the Funder/Sponsor: The National Institute on Aging of the National Institutes of Health (K23 AG058806-01) and the National Institute of Mental Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Mehrotra  A , Chernew  M , Linetsky  D , Hatch  H , Cutler  D . The impact of the COVID-19 pandemic on outpatient visits: practices are adapting to the new normal. Commonwealth Fund. Published June 25, 2020. Accessed July 15, 2020. https://www.commonwealthfund.org/publications/2020/jun/impact-covid-19-pandemic-outpatient-visits-practices-adapting-new-normal.
2.
Verma  S. Early impact of CMS expansion of Medicare telehealth during COVID-19. Health Aff Blog. Published July 15, 2020. Accessed July 16, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/
3.
OptumLabs. OptumLabs and OptumLabs Data Warehouse (OLDW) Descriptions and Citation. Eden Prairie, MN: n.p., May 2019. PDF. Reproduced with permission from OptumLabs. https://www.optumlabs.com/
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Centers for Medicare & Medicaid Services. President Trump expands telehealth benefits for Medicare beneficiaries during COVID-19 outbreak. Newsroom. Published March 17, 2020. https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak.
5.
Centers for Medicare & Medicaid Services. List of telehealth services. Updated April 30, 2020. Accessed July 15, 2020. https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.
6.
Baum  A , Barnett  ML , Wisnivesky  J , Schwartz  MD .  Association between a temporary reduction in access to health care and long-term changes in hypertension control among veterans after a natural disaster.   JAMA Netw Open. 2019;2(11):e1915111-e1915111. doi:10.1001/jamanetworkopen.2019.15111PubMedGoogle ScholarCrossref
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