Examining the State of Telehealth During the COVID-19 Pandemic

Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors.

Telehealth, the remote delivery of clinical services via telecommunications technology, readily connects patients with providers outside of traditional care settings. Given the need for expanded health care resources and the avoidance of in-person contact, telehealth has played a critical role during the COVID-19 pandemic. To meet the needs of patients seeking care during this public health crisis, federal and state agencies are relaxing existing telehealth regulations, and private plans are making related changes. While born of necessity, the expanded use of this service may have a long-lasting impact on the U.S. health care system.

To help illuminate the state of telehealth at this pivotal moment, FAIR Health—a national, independent nonprofit organization dedicated to promoting transparency in health care costs and health insurance information—has released the Monthly Telehealth Regional Tracker, a new, interactive feature on its website. Drawing on FAIR Health’s database of over 31 billion private health care claim records—the largest such repository in the nation—the Tracker offers insights into the month-by-month evolution of telehealth in every region of the country as the COVID-19 pandemic evolves.

The Monthly Telehealth Regional Tracker uses FAIR Health data to present an interactive map of the four U.S. census regions and allows users to view an infographic on telehealth in a specific month in each region, or in the nation as a whole. Each infographic includes a 2019 vs. 2020 comparison of telehealth’s volume of claim lines for that month, urban vs. rural usage, the top five procedure codes, and the top five diagnoses.

To understand the extent to which telehealth use has grown in New York State (NYS), FAIR Health has developed infographics for February and March 2020 on the Monthly Telehealth Regional Tracker. This commentary and the following infographics explore 2019 vs. 2020 comparisons for February and March in NYS and consider these findings in relation to the entire Northeast region. 

In February, telehealth claim lines in NYS rose from 0.14 percent of all medical claim lines in 2019 to 0.52 percent in 2020, a 274.45 percent increase. During that period, claim lines grew 174.3 percent in the Northeast and 121.3 percent nationally

Analysis of telehealth Current Procedural Terminology (CPT) codes in February in NYS reveals that CPT®*  99444 (physician/health care professional evaluation and management of patient by internet) was the most utilized CPT code in February 2019, but that position was filled by CPT 99213 (established patient visit) in February 2020. In addition, CPT 90834 (45-minute psychotherapy) rose from third to second place in 2020, and CPT 90837 (60-minute psychotherapy) reached the top five. This is similar to the distribution for the Northeast region, with the exception of CPT 99201 (new patient visit) being in the top five in 2019.

The top diagnoses in February in NYS differed only slightly between 2019 and 2020. The top two remained the same, with General Signs and Symptoms (e.g., fever, chest pain, and headache) the third most common diagnosis in 2020, replacing Skin Infections and Issues from the prior year. This change in distribution is similar to that of the Northeast in 2020, where General Signs and Symptoms also became more prevalent.

NYS saw a rise in telehealth use from 0.16 percent of all medical claim lines in March 2019 to 7.34 percent in March 2020, amounting to a 4,515.34 percent increase. During the same period, the Northeast region experienced growth of 15,503.20 percent, a much larger overall change compared to NYS. The dramatic rise in telehealth’s share of medical claim lines in March—a product of both increased telehealth services and fewer elective procedures as the COVID-19 pandemic escalated rapidly—is also apparent nationally, where telehealth grew 4,347 percent. 

The infographic also reveals a shift in the top procedure codes in NYS from March 2019 to March 2020. CPT 99444 (physician/health care professional evaluation and management of patient by internet) was the top procedure code in March 2019, but CPT 99213 (established patient visit) filled that position in 2020. In addition, CPT codes 90834 (45-minute psychotherapy) and 90837 (60-minute psychotherapy) became the second and fourth most utilized codes in NYS this year. This new distribution is similar to changes that occurred in the Northeast.

The top diagnoses conducted via telehealth remained generally the same in March 2019 and 2020. In both NYS and the Northeast, Mental Health Conditions and Acute Respiratory Diseases and Infections were the top two diagnoses in 2019 and 2020.  

As the COVID-19 pandemic further affects the nation, FAIR Health anticipates even greater growth in the use of telehealth and will continue to monitor it month by month as this venue of care is transformed. 

*CPT © 2019 American Medical Association (AMA). All rights reserved.

Robin Gelburd, JD, is the President of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to health care costs and health insurance information. FAIR Health possesses the nation’s largest collection of private health care claims data. 

United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Robin Gelburd, the President of FAIR Health, shares some of her organization’s recent data on telehealth and offers insights on how this important service is evolving during the pandemic. – UHF President Tony Shih

June 29, 2020