Healthcare News of Note: Telehealth visits are more often coded with a lower billing code than in-office visits

• Some53.7% of primary care telehealth visits for established patients were coded at LOS 3, compared to 43.3% of primary care office visits.
• In 2022, 6.9% of adults answering a National Health Interview Survey indicated they’d ever had long COVID and 3.4% said they had long COVID at the time of the survey.
• Boston Medical Center Corporation earned the No. 1 spot in the Lown Institute’s annual ranking of the country’s 50 most racially inclusive hospitals.

Over the past few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. Telehealth visits are more often coded with a lower billing code than in-office visits

“For both primary and specialty care, telehealth visits are more frequently coded with a lower level-of-service billing code than in-person office visits of the same specialty,” states a Sept. 12 press release by Epic Research.

Other findings from the study, which evaluated the level-of-service (LOS) billing codes for 1.3 million telehealth visits and 5.2 million office visits from Jan. 1, 2022, through June 30, 2023, included:

• The most common LOS codes for primary care visits, across both telehealth and office visits, were LOS 3 or LOS 4   
• 53.7% of primary care telehealth visits for established patients were coded at LOS 3, compared to 43.3% of primary care office visits
• 40.8% of primary care telehealth visits were coded at LOS 4, as were 52.5% of primary care office visits for established patients
• 56.8% of specialty telehealth visits were coded at LOS 4 or 5, compared to 64.1% of specialty office visits

J.D. Power study: Generational gap in use of telehealth

On Sept. 28, J.D. Power released results of a study showing overall satisfaction with the use of telehealth mobile apps for “routine follow-ups, treatment of minor illnesses and mental health service” when compared with other channels, and also the emergence of a generational gap in use of virtual health apps.

Specific study results include:

• Overall patient satisfaction with telehealth is 698 on a 1,000-point scale.
• Satisfaction scores are significantly higher (714) among members of Gen Y and Gen Z.
• Satisfaction scores are significantly lower (671) among boomers and pre-boomers.

The study authors note, “The satisfaction gap is widest in digital channels and appointment scheduling, suggesting that older telehealth users are having problems using telehealth providers’ digital interfaces.”

See the press release for additional survey results, including trust as an issue, speed and convenience as drivers of telehealth utilization, and the need for providers to make apps easier to use.

“Some studies have suggested that telehealth visits are more often used for chronic disease management, existing patient follow-up, and medication management, which are typically considered less complex visits than new patient visits or visits that require a physical assessment,” wrote the researchers, who noted more research is necessary to determine the factors behind the coding differences.

HFMA insight

HFMA continues to provide coverage of telehealth, including:

• The article “The evolution of telehealth and the potential for sustainability,” by freelance writer Elizabeth Barker, published in August.
• The cover story “Telehealth is primed for growth despite post-lockdown fade,” published in hfm’s May 2022 issue and written by hfm Managing Editor Eric C. Reese, PhD.

2. 6.9% of adults in the U.S. in 2022 reported ever having long COVID

In 2022, 6.9% of adults answering a National Health Interview Survey indicated “they ever had Long COVID and 3.4% [said they] had Long COVID at the time of the survey,” according to a National Center for Health Statistics Data Brief released in September by the Centers for Disease Control & Prevention (CDC).

According to the CDC, “Long COVID is a wide range of new, returning, or ongoing health problems that people experience after being infected with the virus that causes COVID-19. Most people with COVID-19 get better within a few days to a few weeks after infection, so at least 4 weeks after infection is the start of when Long COVID could first be identified.”  

Researchers determined the prevalence of long COVID based on whether survey participants responded “yes” to a question about having symptoms of COVID-19 that lasted three months or longer, that they had not experienced prior to having COVID, and that they experienced “after receiving either a positive test or a doctor’s diagnosis of COVID-19 and were symptomatic,” according to the brief.

Key findings

Researchers also noted the following additional survey findings:

• Women (8.5%) were more likely than men (5.2%) to ever have long COVID.
• Women (4.4%) were also more likely than men (2.3%) to report having long COVID at the time of the survey.
• Adults 35-49 years old were more likely (8.9%) than adults 18-34 years old (6.9%), 50-64 years old (7.6%) and 65 and older (4.1%) to report ever having long COVID.
• Adults 35-49 years old (4.7%) were more likely than those ages 18-34 years old (2.7%), 50-64 years old (3.8%) and 65 and older (2.3%) to report having long COVID at the time of the survey.

The data brief also describes how the share of adults who ever had long COVID or who currently had long COVID differed by urbanization level, by family income as a percentage of the federal poverty level, and by race and Hispanic origin.

“Data from the Nationwide Blood Donor Seroprevalence Survey suggest that 77.5% of people ages 16 and older had antibodies indicating a previous COVID-19 infection as of December 2022,” wrote the authors.

3. Boston Medical Center named the most racially inclusive hospital in the U.S.

Boston Medical Center Corporation earned the No. 1 spot in the Lown Institute’s annual ranking of the country’s 50 most racially inclusive hospitals, based on a review of the 2021 Medicare data of 3,146 hospitals, according to a Sept. 19 news release.

“Disparities in healthcare outcomes and access are well-documented in communities of color, including higher rates of chronic conditions, lower life expectancy, and lower rates of private insurance,” states the release. “Lown examined the racial and ethnic demographics of patients to gauge how effectively hospitals target care to those populations. Racially inclusive hospitals served more patients of color than expected based on the demographics of their service area.”

Top 10 hospitals

The Lown Institute ranked the top 50 most racially inclusive hospitals, with the top 10 listed below:

1. Boston Medical Center Corporation
2. John H. Stroger Jr. Hospital, Chicago
3. UChicago Medicine
4. Penn Presbyterian Medical Center, Philadelphia
5. Metro Nashville General Hospital
6. South Coast Global Medical Center, Santa Ana, California
7. St. Charles Madras, Oregon
8. Grady Memorial Hospital, Atlanta
9. Methodist Hospitals, Gary, Indiana
10. Emory University Hospital Midtown, Atlanta

Key takeaways

Insights derived from the rankings included:

• Of the 3,142 hospitals included in the study, top and bottom performers were rare. Only 3% received 5 stars (highest score), and 6% received 1 star (lowest score).
• Some of the most and least racially inclusive hospitals are concentrated in the same metro areas, reflecting segregation in the healthcare market.
• New Orleans, St. Louis and Detroit top the list of 11 metropolitan areas identified by Lown as having significant hospital-market segregation. All 11 areas had more than 20% of their hospitals ranked most or least inclusive.

Additional takeaways and the study methodology are available in the full online report.

HFMA bonus content

• Read the October issue of hfm magazine, including the cover story “How AI is about to change healthcare,” by contributing writer Lisa A. Eramo, MA; National Chair Dennis Dahlen’s column “It’s time to stop dragging our feet on generative AI”; and the Chapter News column “Maryland Chapter event focuses on inclusion and equity,” by Crystal Milazzo, senior editor.
• HFMA’s comments on Medicare’s 2024 proposed rule for outpatient care and ambulatory surgical centers has been posted on our Regulatory and Accounting Resources page.
• Learn how three leading healthcare organizations are using advanced decision support systems to evaluate volume trends, financial performance and clinical outcomes in this virtual event, “HFMA Educational Workshops: 3 Decision Support Success Stories,” on Oct. 23.