Purpose
To evaluate the effect of telemedicine initiatives on restoring and maintaining access to an interventional radiology clinic at an academic medical center during the COVID-19 pandemic
Materials and Methods
Institutional billing and administrative data were retrospectively reviewed over a 52-week period, from September 2019 to August 2020. Phase 1 (29 weeks) represented pre-pandemic, normal operations. Phase 2 was the period when telephone encounters were available (11 weeks), with Phase 3 representing the period when both telephone and video encounters were available (12 weeks). The final day of in-person clinic visits was March 23, 2020. Telephone visits were initially used to maintain clinic access for patients. After a period of development and testing, video consultation was available after 76 days. Guidelines and requirements related to the provision of telemedicine services, as outlined at institutional, state and national levels, were adhered to over the study period. Visit type and basic patient demographic information was recorded.
Results
There were 6,522 clinic visits over the study period. In the pre-pandemic period (Phase 1), telephone encounters represented 2.4% of monthly clinic encounters (range 0.4 – 3.7%), with a total of 104 telephone visits completed in this time. In phases 2 and 3, the monthly telephone encounters ranged from 242 to 466, representing 70% - 86% of all clinic encounters. There were 420 video visits completed in Phase 3, representing between 25.4% - 32% of monthly clinic encounters. Of these video encounters, 35.2% were performed at satellite centers, with the remainder performed by providers on the main campus. Telemedicine services were provided to residents of 41 states and the District of Columbia; however, provision of services was contingent on the patient’s physical location at the time of the encounter, based on billing and licensing requirements. Out-of-state residents represented 15% and 27.2% of video and telephone encounters, respectively. With the availability of both telephone and video visits in Phase 3, clinic encounters in June, July and August were at 98.7%, 104% and 87.7% of average monthly pre-pandemic volume, respectively. However, despite restoration of clinic encounters in phase three to 96.4% of pre-pandemic levels, billing for Evaluation and Management lagged behind, reaching 38.9% of pre-pandemic levels in the same period.
Conclusions
Despite a precipitous fall in clinic volume in the earliest days of the pandemic, roll-out of telemedicine services allowed for restoration of clinic volumes to near pre-pandemic levels.