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Background:Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment. Methods:The nonrandomized, prospective, multisite research design involved two active treatment groups—a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort. Results:Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic. Conclusions:In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background:Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods:We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results:We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions:Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others. [ABSTRACT FROM AUTHOR]