Use of Telehealth by Surgical Specialties During the COVID-19 Pandemic

Given the US health care system mandates to minimize patient and clinician exposure to COVID-19, telehealth use across all specialties increased dramatically in the COVID-19 pandemic. Telehealth for preoperative and postoperative surgical follow-up patient visits had started to occur at low levels before the pandemic. The extent to which different surgical specialties were able to adjust to telehealth as the major modality of health care delivery remains unclear. This statewide cohort study aimed to determine how telehealth use patterns changed across surgical specialties before and during the COVID-19 pandemic. For the primary analysis, new adult outpatient visits with a surgeon (including colorectal surgery, general surgery, neurosurgery, obstetrics and gynecology, ophthalmology/ear, nose, and throat, orthopedics, plastic surgery, thoracic surgery, and urology) between January 5 and September 5, 2020, were identified from a large commercial insurance payer in Michigan. Patient visits were categorized as in-person office visits or telehealth visits using appropriate telehealth modifier codes. The pandemic was stratified into 3 periods based on national and state regulations, as well as trends in raw data: period 1 (pre-COVID-19 pandemic, January 5 to March 7), period 2 (early pandemic, March 8 to June 6), and period 3 (late pandemic, June 7 to September 5). The primary study outcome was telehealth conversion in 2020. This outcome was defined as the rate of new patient telehealth visits per week divided by the mean weekly new patient visit volume in 2019 over the corresponding period. Trends in overall telehealth surgical use over time were created, and rank sum test analyses were used to assess differences in patient characteristics between those who used telehealth and those who did not. Of the 4405 surgeons included in the analysis, 2588 (58.8%) used telehealth in the study period and 1182 (26.8%) used telehealth for new patient visits. A total of 109,610 surgical new patient visits occurred between March 8 and September 5, of which 6634 (6.1%) were telehealth and 102,976 (94.0%) were in-person. A total of 8 telehealth visits (<0.1%) occurred during the same period in 2019. Telehealth conversion rate peaked in April 2020 with 8.2% of prior year visits and began a slow decline after June 2020 to a conversion rate of 2.1% at the study conclusion. The median age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for in-person visits (P < 0.001). Patients in rural areas were less likely to use telehealth compared with those in nonrural areas (867 of 18,531 [4.7%] vs 5655 of 82,910 [6.8%]; P < 0.001). Patients in low-median income zip codes were less likely to use telehealth compared with those in above-median income zip codes (3065 of 50,304 [6.1%] vs 3457 of 51,137 [6.8%]; P < 0.001). Neurosurgery and urology were the specialties with the highest telehealth conversion rate. In period 2, urology had a mean (SD) conversion rate of 14.3% (7.7%) of new patient visits. In period 3, neurosurgery had a mean (SD) conversion rate of 13.8% (3.7%) of new patient visits. The telehealth conversion rate for other surgical subspecialties, including obstetrics and gynecology, was less than 10%. The results of this study find that, in Michigan during the COVID-19 pandemic, a significant increase in telehealth use across all surgical specialties was observed with significant variation between surgical specialties.