Telephone Visits Gap Vulnerable Populations Blog Post Aptitude Health Oncology Hematology

Since the outbreak of COVID-19, telehealth has emerged as a way to continue patient care while minimizing risk of virus exposure. Interestingly, telehealth visits are not always on a screen. Many patients—particularly those who are older or have lower incomes—prefer to communicate with their providers via telephone over video visits. When parts of the US first went into lockdown, 2 clinics reported that as many as 50% to 75% of patient visits were handled by telephone. The Centers for Medicare & Medicaid Services stated that nearly a third of patients who received telehealth services in Spring 2020 did so using audio-only telephone calls. In tribal communities, telephone visits composed about 80% of virtual visits.

While not without limitations, this approach has some distinct benefits, as described by Mary Chris Jaklevic, MSJ, in a 2020 JAMA Medical News & Perspectives article. For example, telephone visits enable ongoing communication with vulnerable populations who may struggle with technology or who have responsibilities that interfere with their ability to have a video or in-person visit. These populations include the 13% of US residents who do not have high-speed internet, and as many as 25% of Medicare beneficiaries who lack a smartphone or a computer with broadband access. These percentages are higher among low-income, Black, and Hispanic beneficiaries and among those with disabilities.

Many practices continue to rely on the telephone to provide a range of services that were once handled face-to-face. These visits may offer an effective way to triage patients; physicians can take medical histories, order or follow up on lab and imaging tests over the phone, and decide whether an in-person visit is needed. Telephone visits can also help physicians monitor patients with chronic conditions, such as cardiovascular disease, hypercholesterolemia, and some hematologic conditions. From the patients’ perspective, some people prefer the privacy that telephone visits afford, and many value the convenience and the safety of avoiding close contact.

Some US payors and physician groups are advocating for continued use of telephone visits even after COVID-19 restrictions are lifted. At least 2 US states have passed legislation for Medicaid coverage of telephone visits after the pandemic.

One limitation of telephone visits is that communicating by phone doesn’t allow a physician to observe a patient’s nonverbal cues, which are sometimes vital to reading a patient’s emotions, gauging whether they understand the information being discussed, and building rapport. It also removes the “human touch,” and is inappropriate when delivering devastating news to patients and their families. Therefore, decisions on the appropriateness of this care model will need to be patient-specific and based on individual circumstances.

High level: Physician organizations seeking continued reimbursement for telehealth visits post-pandemic will need to be able to provide data on the improvements in quality, cost-effectiveness, and access that they afford. For example, it will be interesting to learn whether remote visits for patients with chronic conditions affect hospitalizations or emergency department visits. Now that many patients have become accustomed to telehealth visits, payors should consider the impact and potential backlash of removing those services after the pandemic.

Ground level: For patients with chronic conditions or other health issues, a hybrid arrangement that includes both in-person and telephone visits may be a useful approach. This enables continuity of patient care while supporting the provider-patient relationship and showing patients that their time and resources are respected.