Has telehealth utilization since the onset of the COVID-19 pandemic in 2020 had a significant impact on overall patient care utilization? A team of researchers, publishing their research in the May issue of Health Affairs, has investigated the question, and found mixed results.
The team of researchers—Carter H. Nakamoto, David M. Cutler, Nancy D. Beaulieu, Lori Uscher-Pines, and Ateev Mehrotra—has found, overall, a modest increase in outpatient use of telehealth/telemedicine as one modality of care over the past few years, but no explosion, as some had predicted. Writing in an article entitled “The Impact of Telemedicine On Medicare Utilization, Spending, And Quality, 2019-22,” they write that “Telemedicine use remains substantially higher than it was before the COVID-19 pandemic, although it has fallen from pandemic highs. To inform the ongoing debate about whether to continue payment for telemedicine visits, we estimated the association of greater telemedicine use across health systems with utilization, spending, and quality. In 2020, Medicare patients receiving care at health systems in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use. In 2021–22, relative to those in the lowest quartile, Medicare patients of health systems in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease), a $248 increase in per patient per year spending (1.6 percent relative increase), and increased adherence for metformin and statins. There were no clear differential changes in hospitalizations or receipt of preventive care.”
Importantly for this policy discussion, the authors note that “Congress temporarily extended Medicare’s broad coverage of telemedicine, including flexibilities on where patients are located, through December 2024, after which, without any congressional action, broad coverage of telemedicine in the Medicare program will end.” (Close observers of Capitol Hill are indicating that they believe that Congress will act this autumn on potential extensions.) “A major impediment to long-term coverage of telemedicine,” the article’s authors note, “has been concerns that it will increase spending or hurt quality. To inform long-term policy, policy makers have called for more research to increase understanding of how the growth in telemedicine during the pandemic affected health care spending and the quality of care that patients received.”
Per that, the researchers note that, “To estimate the impact of greater telemedicine use, we exploited the variation in telemedicine uptake across health systems during the COVID-19 pandemic. Patients receiving care from health systems in the highest quartile of telemedicine use had modest increases in office visits, care continuity, and medication adherence, as well as decreases in ED visits, relative to patients of health systems in the lowest quartile,” they found.
Importantly, “Given concerns that telemedicine’s convenience will lead to more visits, the relatively small increase in visits that we observed was somewhat surprising. It may be explained by several factors,” the article’s authors write. “Clinicians in the health systems in the highest quartile of telemedicine use may have had limited capacity to provide additional visits. Alternatively, there may have been limited demand from patients for telemedicine as a result of technological barriers or beliefs that telemedicine visits were lower in quality than in-person visits. Moving forward,” they note, “it will be important to continue monitoring telemedicine’s impact on quality and spending.”
Given all these factors, the researchers conclude that, with policymakers signaling “that they are willing to accept small increases in spending due to telemedicine,” “Given the small improvements in access and quality (in particular for chronic disease medications), combined with modest increases in spending along with patients’ and clinicians’ preferences, we believe that it will be difficult to justify a return to restricting telemedicine payment in Medicare.”
