Patients shirked diagnostic testing, in-person preventive care amid telehealth boom this spring

Dive Brief:

  • Patients overwhelmingly turned to telehealth visits early in the COVID-19 pandemic but skipped out on diagnostic procedures and other preventive and elective care that can only be done in-person, according to a study published Thursday in JAMA Network Open.
  • The number of mammograms and colonoscopies performed in March and April dropped more than 65% compared to the year prior, according to the analysis of more than 5 million commercially insured patients. Overall, healthcare utilization dropped 23% in March and 52% in April.
  • Telemedicine visits jumped 4,000% compared to the year prior, but only replaced about 40% of the drop in in-person visits. Telehealth utilization among patients in lower-income or predominately non-White ZIP codes was about one-third lower than for those in the wealthiest neighborhoods, researchers found.

Dive Insight:

Telehealth exploded out of necessity when the pandemic hit. But providers can’t deliver all their services virtually, including routine diagnostic procedures used to detect major health conditions before they progress.

“This is something that is undoubtedly going to have impacts for both patients and the provider delivery system,” Christopher Whaley, the study’s lead author and a policy researcher with nonprofit think tank RAND said.

Researchers looked at insurance claims data from 2018 to 2020 from about 200 employers. Beyond major declines for mammograms and colonoscopies, they found other procedures like musculoskeletal surgery, cataract surgery and MRIs all dropped by 45% or more.

“If a younger, healthier woman misses her mammogram appointment or gets it pushed back several months, that’s probably okay from a health standpoint,” Whaley said. “But there are high-risk patients who, if they miss routine screenings like that, there could potentially be an increase in cancer rates or you might miss something that can be treated more easily if you caught it early.”

In-person visits to manage chronic conditions dropped too, including blood sugar tests for patients with diabetes, which fell more than 50% in March and April. Chemotherapy treatments dropped 4%.

And among children under 2 years old, vaccinations dropped 22%.

“There’s got to be a really collaborative environment between patients, providers and payers to make sure that patients who’ve missed necessary care actually get caught back up,” Whaley said.

Some hospitals have turned toward artificial intelligence and other tech to help them best maintain routine care amid COVID-19 surges. Another recent report in JAMA Network Open outlined how researchers found a clinical decision support tool could help facilities best manage their resources to keep electives going.