Telemedicine Outpatient Cardiovascular Care During the COVID-19 Pandemic

Abstract

D uring the coronavirus disease 2019 (COVID-19) pandemic, it is critical that patients maintain access to routine care while simultaneously limiting community spread of the virus. Given this, the Centers for Medicare & Medicaid Services and other insurance payers expanded reimbursement for ambulatory visits via telehealth interactive communications systems. Initially, full reimbursement was restricted to visits using video as opposed to telephone only. Recent regulatory updates have improved reimbursement for telephone visits; however, these changes are temporary and do not apply to all types of telephone visits or payers. 1 Many ambulatory clinics have exponentially increased telemedicine use, with strong preference for video visits. The use of technology for maintenance of care may exacerbate inequities. Vulnerable patients, including poorer patients, older patients, and non-English-speaking patients, may have increased barriers to engaging in care via telemedicine, particularly video visits. The aim of this study was to compare the demographics of patients with completed telemedicine encounters in the current COVID-19 era at a large academic health system with those who were scheduled but did not complete a visit. We also identified factors associated with a completed telemedicine visit and video compared with telephone encounters. Using the electronic medical record, we extracted demographic information for adult patients (≥18 years of age) scheduled at the general/subspecialty cardiology clinics at our institution from March 16, 2020 (after local shelter-in-place order and transition of clinics to complete telehealth platform) to April 17, 2020. On the basis of billing, we determined whether patients had completed a telemedicine encounter (and if telephone or video) or had not (canceled/no show). Median household income from the American Community Survey 2 was linked to patient zip code. Differences in patient characteristics between completed and noncom-pleted visits and between video and telephone visits were compared by use of χ 2 and t tests. Multivariable logistic regression was used to identify factors associated with a completed telemedicine visit (telephone or video), as well as video use specifically. This project was reviewed and determined to qualify as quality improvement by the University of Pennsylvania's Institutional Review Board; no informed consent was required. A total of 2940 patients were scheduled during the study period. Of those, 1339 (46%) had a completed telemedicine encounter, and 1601 (54%) had a canceled/no-show visit. On unadjusted analysis, patients with a completed tele-medicine visit were slightly older (mean age, 63 versus 62 years; P<0.0001), were more likely to be male (51% versus 44%; P<0.0001), and were more likely to speak English (99% versus 98%; P=0.03). Between groups, there were no differences based on race/ethnicity (P=0.25), insurance/payer class (P=0.12), or zip