A RAND study of telehealth traffic at federally qualified health centers in California serving low-income residents found that almost half of all primary care visits and about 64 percent of behavioral health visits conducted via telehealth between March and August of 2020 used audio-only phones. This suggests that audio-only phones may be key to telehealth access for underserved populations; however, it could become a problem post-pandemic. During the COVID-19 public health emergency, the federal and state governments have implemented numerous emergency measures in order to increase telehealth access and coverage. This included enabling providers to treat patients through audio-only telehealth, generally through a phone call. However, most of these freedoms will end once the public health emergency is over, and there is significant disagreement about whether audio-only telehealth coverage should be permanent.
Lori Uscher-Pines and her team of researchers investigated the extent of telehealth usage at 41 Federally Qualified Health Centers (FQHCs) with more than 500 clinic sites supported by the California Health Care Foundation. Their findings were published in the Journal of the American Medical Association as part of the RAND study. According to the research, COVID-19 has drastically shifted the number of primary care and behavioral health visits to connected health platforms. Approximately 50% of primary care visits and 77% of behavioral health visits are now conducted via these platforms. Unfortunately, many of these services are administered via phone due to insufficient tech access and broadband capability, preventing patients from utilizing audio-visual telemedicine.
Advocates for telehealth have highlighted the audio-only platform as a possible way to increase healthcare access for people who are underserved. However, the Centers for Medicare & Medicaid Services have questioned if the telephone is suitable for healthcare services. As Congress, CMS, and state governments continue to evaluate telehealth options, RAND’s senior policy researcher, Uscher-Price, has expressed her concern over the possibility of eliminating coverage for telephone visits. She believes that lower-income patients could be negatively impacted due to lack of access to video visits, and federally qualified health centers may not have the necessary infrastructure to carry out video telehealth. It is essential for policymakers to consider these issues as telehealth is becoming more accepted.
