Table 1.
Outpatient Visits and Payments for Telehealth and In‐Person Outpatient Encounters Among Patients With Cardiovascular Disease, MarketScan Commercial Claims and Encounters Database, July 2020 to June 2021
| Encounters | Mean (95% CI) |
|---|---|
| Telehealth encounters | |
| No. of telehealth encounters per patient | 4.2 (4.16–4.25) |
| Total payments per encounter | $113.1 ($112.8–$113.5) |
| Patient OOP payments per encounter | $23.8 ($23.6–$24.0) |
| Share of patient OOP payments to total payments per encounter | 23.2 (23.1–23.4) |
| Sample size, n | 119 689 |
| In‐person encounters | |
| No. of in‐person encounters per patient | 37.5 (37.3–37.7) |
| Total payments per encounter | $160.9 ($159.8–$161.8) |
| Patient OOP payments per encounter | $32.7 ($32.5–$32.8) |
| Share of patient OOP payments to total payments per encounter | 27.6 (27.5–27.7) |
| Sample size, n | 308 130 |
Cardiovascular disease (CVD) was defined after excluding hypertension diagnosis alone (ICD‐10‐CM codes I10–I15) from CVD (ICD‐10‐CM codes I00‐I78). Patients with CVD (ICD‐10‐CM codes I00–I09, I16–I78) were defined if inpatient or emergency department encounters contained at least 1 diagnosis of CVD, or at least 2 outpatient encounters contained the diagnosis of CVD with at least a 30‐day interval during the 2 years of lookback periods from January 1, 2017 to December 31, 2018. Of the 320 857 patients with CVD (Figure 1), 308 130 (or 96.0%) patients had at least 1 in‐person outpatient encounter, 119 689 (or 37.3%) patients had at least 1 telehealth encounter, 309 590 (or 96.5%) patients had at least 1 in‐person or telehealth encounter, 118 229 (or 36.8%) patients had both an in‐person and telehealth encounter, 1460 (or 0.5%) patients had only a telehealth outpatient encounter, 189 901 (or 59.2%) patients had only an in‐person outpatient encounter, and 11 267 (or 3.5%) patients did not have any in‐person or telehealth outpatient encounters during July 1, 2020 to June 30, 2021. Patients with telehealth outpatient encounters were defined in the following way: the place of service is equal to 2 in MarketScan data for telehealth; and procedure modifiers are equal to 95 for synchronous telemedicine service rendered via real‐time interactive audio and visual telecommunication system; equal to GO for telehealth services for diagnosis, evaluation, or treatment of symptoms of acute stroke; equal to GQ for telehealth service rendered via an asynchronous telecommunications system; and equal to GT for telehealth service rendered via interactive audio and video telecommunication systems. If outpatient encounters contained any of the above telehealth places of service or procedure modifiers from July 1, 2020 to June 30, 2021, we defined them as telehealth outpatient encounters. The cost calculation for in‐person outpatient encounters was defined by taking differences between total outpatient costs and total telehealth outpatient costs. Outpatient encounters were defined if settings contained nonphysician office visits, other outpatient office visits, specialty office visits, primary care physician office visits, or other outpatient (ie, all encounters excluding inpatient, emergency department, laboratory test, and pharmacy). Total payments for in‐person and telehealth were defined by the average payment per outpatient encounter for in‐person and telehealth encounters, respectively. The OOP payment share was the ratio of patients' OOP payments and total payments. The 95% CIs are the bias‐corrected and accelerated bootstrap 95% CIs with 1000 replications. ICD‐10‐CM indicates International Classification of Diseases, Tenth Revision, Clinical Modification; and OOP, out‐of‐pocket.