Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization

Abstract

BackgroundExpansion of virtual health care—real-time video consultation with a physician via the Internet—will continue as use of mobile devices and patient demand for immediate, convenient access to care grow.ObjectiveThe objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions.MethodsA cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy.ResultsA total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, P<.001; UCC: 39.01%, P<.001; ED: 53.15%, P<.001; PCP: 37.40%, P<.001), and imaging rates for virtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, P<.001; ED: 43.06%, P<.001; PCP: 11.26%, P<.001). RHC, UCC, ED, and PCP were estimated to be $36, $153, $1735, and $162 more expensive than virtual visit episodes, respectively, including medical and pharmacy costs.ConclusionsVirtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care.

Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study

“…This is consistent with previous research showing that virtual visits can complement existing patterns of care and, in fact, reduce overall primary and urgent care visits for patients [18,36]. Similarly, an evaluation by the US National Institute of Justice found that virtual care more generally (including synchronous and asynchronous care) has specific value for defined patient populations, reducing external visits to specialists and costly off-site transfers for care of prisoners [37] and providing a cost-effective solution for patients with limited access to mental health services [38].…”

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

“…Twenty-three contributed to the narrative summary and are cited in the paper. These included 2 RCTs [36,37], 13 nonrandomized comparative studies [6,8,[38][39][40][41][42][43][44][45][46][47][48], and 7 single group studies [49][50][51][52][53][54][55], and the remaining articles [5,7,39,41,43,46,50,53, included consensus documents, cost-effectiveness analyses, and narrative reviews. Of note, most of our literature review and review of expert opinion was in line with the International Guidelines from the Infectious Disease Society of America (IDSA) and European Society for Microbiology and Infectious Disease (ESMID) recommendations, including choice of antibiotic for first-line therapy [84].…”

“…& Telemedicine with empiric antibiotic therapy is effective and lowers costs, but results in more prescribing and therefore may negatively impact antibiotic resistance [5,8,6,[57][58][59][60]76]. & The symptoms of dysuria, worsening frequency or urgency, gross hematuria, and lack of vaginal symptoms are significantly predictive of the presence of a UTI [44,61].…”

Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project (Preprint)

“…[11][12][13][14][15][16][17][18][19][20] A 2015 review identified 27 published studies of the use of Skype™ and similar technologies in clinical care, all but one of which reported positive benefits. [12] Most of these studies, and those published since (e.g.…”