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Telehealth reduces cancellations for care during COVID-19 pandemic in large Ohio health center

Some patients remain wary of going into the clinic, with lack of transportation and other issues being a nagging barrier.

Jeff Lagasse, Associate Editor

Expanded use of telehealth during the COVID-19 pandemic has improved cancellation rates, no-shows and completed medical visits for rheumatology ambulatory clinics in one large Ohio health system, shows new research presented at ACR Convergence, the American College of Rheumatology's annual meeting.

Telehealth may be practiced using webcams, smartphones, secure video messaging platforms or other technology. All modalities used are HIPAA compliant.


When COVID-19 surged worldwide in early 2020, many rheumatology clinics and practices cut back on their in-patient care services to reduce the risk of infection spread among their vulnerable patients, many of whom take immune-system-suppressing drugs that put them at higher risk for serious infections. Some patients remain wary of going into the clinic for routine care due to COVID, and a lack of transportation and other issues had been a nagging barrier to rheumatology care in the past.

Researchers wanted to know if telehealth could bridge gaps in access to rheumatology care, allowing medical visits with physical distancing and eliminating the need for a time-consuming or costly trip to the clinic. A team at MetroHealth Medical Center in Cleveland, Ohio, compared data on completed clinic visits, no-shows and cancellation rates between their in-person and telehealth appointments for rheumatology clinics in 2020.

They pulled retrospective data from their electronic health record system for rheumatology outpatient appointments between January 3 and May 31. Appointments were placed in three categories: canceled, no-show or completed. They divided all the data into two 10-week periods: a pre-COVID-19 phase from January 3 to March 15, and a COVID-19 phase from March 16 to May 31. During the pre-coronavirus phase, there were only in-person clinic visits, while in the second phase, the clinic offered telehealth or in-person visits to their patients.

Telehealth appointment cancellations were nearly zero in the COVID-19 phase, or one out of 825 telehealth appointments scheduled, compared to the pre-coronavirus phase, when 527 out of 1677 appointments, all in person, were cancelled. No-shows also trended downward when telehealth became an option for care. 

In the COVID-19 phase of the study, the clinics had 191 no-shows, including 121 in-person and 70 telehealth no-shows. In the pre-COVID-19 phase, when only in-person care was offered, there were 220 no-shows. 

During the coronavirus period, MetroHealth Medical Center also had slight increases in visit completions with telehealth as an option for rheumatology care: 1,038 completed visits, including 754 telehealth and 284 in-person visits out of 1,675 scheduled visits, compared to only 930 completed visits out of 1,677 scheduled, all in person, in the phase of the study before COVID-19.

Based on these findings, MetroHealth's Division of Rheumatology aims for 40% of future follow-up visits to be performed through telehealth.


As of October, providers have 11 additional telehealth services that will be reimbursed by the Centers for Medicare and Medicaid Services during the public health emergency. Medicare will begin paying eligible practitioners for these services immediately, and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services.

In 2020, virtual care is expected to account for more than 20% of all medical visits in the U.S., which in turn is projected to drive $29 billion in total healthcare services.

Doximity's 2020 State of Telemedicine Report, released in September, also found that up to $106 billion of current U.S. healthcare spend could be virtualized by 2023. This highlights the high rates of adoption among both patients and physicians, and the impetus felt among providers to offer safe, secure and easy-to-use virtual services as demand for telehealth continues to grow.

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