Reply to “Appointment characteristics during COVID-19 restrictions: A Canadian allergy/immunology centre perspective”

To the Editor:

We appreciate the data provided by Zhu et al¹ regarding their experience among 2 academic allergists in Canada from March 16 to May 1, 2020, during the COVID-19 pandemic. We surmise that there are notable differences between our practice characteristics accounting for our perspectives,² but ultimately agree that telemedicine encounters should have an enduring role in future allergy/immunology (A/I) care.

We hypothesize that Zhu et al¹ experienced less cancellations due to their longer study period. Our analyses covered the initial 3 weeks of the shutdown in New York State,² where patients were contending with employment, school, and childcare challenges, while also grappling with the possibility of a severe COVID surge in Western NY. We suspect that many patients delayed their elective A/I appointments given the uncertainty of the times. Over time, our practice experienced a decrease in canceled appointments as patients adjusted to COVID-19-related restrictions in the weeks following our data collection.

The difference between Canadian and American health care may have also played a role in cancellation rates because nationalized health care in Canada leads to longer wait for specialty care,³ so patients in Zhu et al's analysis may have wished to avert further delay of their appointment.

We agree with Zhu et al that there should be a role for telemedicine beyond the pandemic, particularly for certain conditions, as previously discussed in both of our reports,^{1 , 2} and we have shown that our physicians felt the majority of telemedicine encounters to be complete.² We have also found favorable patient feedback regarding telemedicine in a separate report of our COVID-19 experiences.⁴ However, despite their low cancellation rate, we presume Zhu et al canceled all food and drug challenges like our practice did. These are essential diagnostic tools in our specialty, and the majority of these cannot be completed remotely.

Importantly, telephone encounters outnumbered telemedicine encounters for both groups, and this represents a significant challenge for adequate reimbursement. Despite the rapid adoption of telemedicine, reimbursement in New York State remains suboptimal compared with in-person visits, and this has an impact on practice sustainability. Reimbursement must be addressed before A/I practices can successfully integrate telephone and telemedicine visits into their business models. We believe an A/I practice offering a combination of both in-person and telemedicine appointments depending on patient diagnoses and preferences will be the ideal model to maximize efficiency for both provider and patient.