Telemedicine use: Where are allergists now?

| | September 8, 2020

Telemedicine use: Where are allergists now?

The College’s two recent COVID-19 member surveys indicate telemedicine use initially soared among allergists during the first months of COVID-19, and then dropped somewhat as patients were able to return to the office. In the College’s August COVID-19 survey of U.S. members, 90% of respondents indicated they plan to continue telemedicine use following the pandemic, assuming reimbursement continues at existing levels. In our August survey, we also asked what types of visits (new vs. existing) and clinical problems allergists feel most comfortable addressing via telemedicine. Given the importance of telemedicine to our specialty, the Advocacy Council has worked tirelessly to support telemedicine flexibilities and payment parity during the pandemic.

doctor talking to male patient on laptop

August survey demographics

The College surveyed all U.S. College members from 7/30/20 – 8/16/20. A total of 291 members completed the survey, for a completion rate of 8.5%. In addition:

  • 70% of all survey respondents came from single specialty private practice, 11% were from multi-specialty private practice, 8% were academic and 7% were from integrated health systems.
  • 80% of all survey respondents had five or fewer providers in their practice, 11% had six to 10 providers, 5% had 11-20 providers and 4% had more than 20 providers.
  • Survey responses were evenly divided across all five regions of the United States.

Telemedicine results

There have been multiple changes in allergy practice telemedicine use over the past several months. Prior to COVID-19, allergists reported only 1% of all patient visits were via telemedicine. After COVID-19 hit, April survey respondents reported telemedicine visits jumped to 54% of all patient visits, and in-person visits dropped to 30%. However, by the August survey, in-person visits recovered somewhat. Telemedicine visits dropped to 23%, with in-person visits increasing to 66% of all visits. According to Michael Blaiss, MD, FACAAI, the College’s executive medical director, “Patients are likely feeling more comfortable coming back to the office now that procedures are in place to prevent exposure to COVID-19.”

Approximately what percentage of all patient visits are in-person, by telephone and by telemedicine at your practice? (August: 252 responses, April: 351 responses) August Survey April Survey
% In-person visits 66% 30%
% Telemedicine visits (audio and visual) 23% 54%
% Telephone visits (audio only) 11% 16%
Sources: ACAAI COVID Member Survey 7/30/20 – 8/16/20 and ACAAI COVID Member Survey 4/24/20 – 5/3/20. Copyright 2020. Data is protected by ACAAI copyright and is prohibited to be shared or published without ACAAI’s consent.

Allergists expressed strong support for telemedicine use post-COVID-19. An overwhelming 90% of survey respondents said they plan to continue telemedicine use in their practice post COVID-19, assuming reimbursement continues at current levels.

Source: ACAAI COVID Member Survey 7/30/20 – 8/16/20. Copyright 2020. Data is protected by ACAAI copyright and is prohibited to be shared or published without ACAAI’s consent.

More than 50% of survey respondents were comfortable addressing new patient problems during telemedicine visits. The most popular telemedicine visit type, however, was for established patients. 97% plan to continue telemedicine visits for established patient with existing problems vs. 81% for established patient with new problems.

Which of the following telemedicine visit types do you plan on continuing? (check all that apply) (231 responses) # of Responses %
New patient 119 52%
Established patient – new problem 188 81%
Established patient – existing problem 223 97%
Source: ACAAI COVID Member Survey 7/30/20 – 8/16/20. Copyright 2020. Data is protected by ACAAI copyright and is prohibited to be shared or published without ACAAI’s consent.

When asked what patient problems they were most comfortable addressing via telemedicine, allergists clearly preferred using telemedicine for follow-up appointments and patient education. 80% or more of all survey respondents said they are comfortable addressing follow up asthma, follow up food allergy, follow up allergic rhinitis, follow up eczema, follow up drug allergy and patient education via telemedicine. The least popular problems to address via telemedicine were new asthma and new immunodeficiency.

Which of the following patient problems are you comfortable addressing via telemedicine? (check all that apply) (230 responses) # of Responses %
New asthma 64 28%
Follow up asthma 184 80%
New food allergy 117 51
Follow up food allergy 210 91%
New allergic rhinitis 129 56%
Follow up allergic rhinitis 221 96%
New eczema 102 44%
Follow up eczema 197 86%
New drug allergy 127 55%
Follow up drug allergy 183 80%
New immunodeficiency 76 33%
Follow up immunodeficiency 163 71%
Patient education 198 86%
Other (please specify) 17 7%
Source: ACAAI COVID Member Survey 7/30/20 – 8/16/20. Copyright 2020. Data is protected by ACAAI copyright and is prohibited to be shared or published without ACAAI’s consent.

Based on these survey results, we expect allergists will continue to use telemedicine for some visit types depending on reimbursement, but the percentage of telemedicine visits may continue to decline post-pandemic.

Advocacy Council supports telemedicine initiatives

The Advocacy Council has advocated to sustain policy changes that would permanently authorize many of the telehealth changes adopted under the Public Health Emergency 1135 Waiver Authority. We’ve advocated to the Centers for Medicare and Medicaid Services, third-party payers and Congressional leaders. The expanded use and availability of telehealth has been critical in allowing physicians to continue providing necessary care to their patients.

The Advocacy Council specifically asked that the following policies be maintained either through regulation or legislation:

  1. Lifting of geographic limitations for a telehealth visit originating from a rural area.
  2. Lifting the requirement that the patient present at an “originating” site as a condition for payment for a telehealth visit.
  3. Continue ability to use non-HIPAA compliant audio/video communication tools such as Facetime, Zoom, Go-to-Meeting and other individual-to-individual portals available on smartphones and Apple devices.
  4. Maintain expanded list of services that can be provided via telehealth.
  5. Continued authority for providers to voluntarily waive Medicare co-pay or deductible for telehealth visits.
  6. Payment parity between Medicare payments for telehealth visits and in-person visits for the same services.
  7. Maintenance of authority to conduct telehealth visits using audio-only (i.e. traditional telephone).
  8. Maintain flexibilities regarding direct supervision by physicians in teaching hospitals.
  9. Allow physicians to provide telehealth visits across state lines without the need to be licensed in the state in which the patient is located.
  10. Allow a physician to engage in a telehealth visit with established AND new patients.

We will continue to monitor telehealth policies and lobby for the initiatives we feel are most important to you and your patients. The Advocacy Council – we have you covered.