Increase in Telehealth Services Is Not Associated With Duplicative Care


A retrospective study highlights the need to examine sustainable reimbursement structures for telehealth services.

Joshua C. Pritchett, MD

Joshua C. Pritchett, MD

Telehealth can be successfully integrated into cancer care without resulting in duplicative care, according to findings from a retrospective study that were published in JCO Oncology Practice.

Results from the study showed that between 2019 and 2020, the use of telehealth increased from less than 0.01% to 11%. Between 2020 and 2021, the rate increased to 14%. Prior to the roll-out of telehealth programs, there was 1.24 appointments per patient. In 2020, this number increased to 1.25 and, in 2021, fell to 1.23—which was consistent with prepandemic rates.

“Our experiences suggest that telehealth can be deployed as a fully integrated aspect of care within a multisite, multiregional cancer practice, without evidence of duplicative care,” Joshua C. Pritchett, MD, a fellow with the Mayo Clinic in Rochester, Minnesota, and co-investigators wrote in the study.

Prior to the COVID-19 pandemic, telehealth services were not widely used throughout the United States. However, when the US Public Health Emergency (PHE) was declared and nontraditional models of care were implemented, the Centers for Medicare and Medicaid Services increased reimbursement flexibility so that institutions could receive reimbursement for telehealth services. Further, federal and state governments relaxed or, in some cases, removed the licensing barriers that limited telehealth provisions across state lines. Consequently, the nation observed an unprecedented surge in this technology.

In July 2020, the American Society of Clinical Oncology issued an interim policy advising policymakers to continue to expand coverage for telehealth services. Because of these renewed policies, many cancer institutions have continued to leverage telehealth service; however, according to the authors, there are insufficient data regarding the provider- and patient-level factors that influence telehealth use.

To that end, investigators collected and compared outpatient-visit data from across the Mayo Clinic Cancer Practice, which encompasses 3 geographically diverse referral campuses based in Rochester, Minnesota; Scottsdale, Arizona; and Jacksonville, Florida, along with rural community-based hospitals in the upper Midwest. They collected data on the outpatient visits conducted over an 8-week period from July to August from the respective years.

In 2020, 13% of physicians were likely to use a telehealth visit compared with 7% of advanced practice providers, yielding a chi-squared statistic (χ2) of 300.5 (P < .0001). In 2021, 18% vs 8% of these groups were likely to use telehealth services, respectively (χ2, 626.6; P < .001).

In both 2020 and 2021, physicians were also more likely to use telehealth than their hematology/oncology fellows. The rates of use among fellows were 8% in 2020 (χ2, 63.2; P < .001) and 12% in 2021 (χ2, 42.9; P < .0001).

Of note, in 2020, tertiary providers were most likely to use telehealth (OR, 1.091; 95% CI, 1.020-1.123; P < .0003).This tendency became pronounced in 2021 (OR, 1.136; 95% CI, 1.080-1.170; P < .0001).

Regarding patient preferences, the study revealed that nonrural patients were significantly more likely to use video visits than their rural counterparts in both 2020 (OR, 1.041; 95% CI, 1.028-1.054; P < .0001) and 2021 (OR, 1.023; 95% CI, 1.008-1.039; P = .003).

Patients older than 65 years were more likely to use video visits in both 2020 (OR, 1.021; 95% CI, 1.004-1.038; P = .0177) and 2021 (OR, 1.035; 95% CI, 1.014-1.056; P = .0009). Hispanic patients were more Lilley to use video visits than non-Hispanic patients (OR, 0.965; 95% CI, 0.937-0.994; P = .0186). Non–English-speaking patients were just as likely to use video health services as those who speak English (OR, 0.960; 95% CI, 0.941-0.980; P < .0001). Male patients were more likely to use video services than female patients (OR, 0.981; 95% CI, 0.972-0.991; P = .0001).

The study also showed that patients were largely satisfied with their telehealth options. In 2019, when asked how likely they were to recommend the practice after a visit, 90.3% of patients (n = 3197) responded that the chances were “very good.” In 2020, after telehealth had been implemented, the “very good” responses were still 91.8% (n = 2508 patients) among in-person patients and 92.1% (n = 362) among the telehealth visit patients. In 2021, 93.1% and 90.5% of patients responded “very good,” respectively.

The study authors concluded by noting that although telehealth has been successfully integrated into many cancer care models with high patient satisfaction, the ability to continue to do so may hinge on whether reimbursement continues to remain available for these institutions.

“With the anticipated end of the PHE declaration, payors' reimbursement structuring and licensing provisions for practice across state lines may significantly affect whether this care model can be sustainably offered to patients going forward,” they wrote. “Future work is needed to help guide effective policy-making in this regard and to ensure that ongoing deployment remains associated with equitable access to patient-centered cancer care.”


Pritchett JC, Borah BJ, Dholakia R, et al. Patient- and provider-level factors associated with telehealth utilization across a multisite, multiregional cancer practice from 2019 to 2021 Published online July 19, 2023. JCO Oncol Pract. doi:10.1200/OP.23.00118

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