Telehealth Linked To Modest Quality, Cost Increases, Study Finds

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Dive Brief:

• Increased use of telehealth among Medicare beneficiaries is linked to some quality improvements and a relatively small bump in healthcare spending — results that could support continued regulatory flexibilities for virtual care, according to a study published Wednesday in Health Affairs. 
• Medicare patients who received care at health systems with high levels of telehealth adoption experienced modest increases in office visits, care continuity and medication adherence, as well as a decrease in emergency department visits compared with systems with low telehealth use. That group also saw a 1.6% increase in healthcare spending. 
• The quality and cost findings mean it could be difficult to defend restricting telehealth payment in Medicare, researchers wrote. Some pandemic-era telehealth flexibilities are scheduled to expire at the end of this year without Congressional action. 

Dive Insight:

Telehealth use soared during the COVID-19 pandemic, aided by relaxed rules aimed at preserving access to care during the public health emergency.

Some of those changes have been made permanent, but other flexibilities — like allowing Medicare patients to receive telehealth in their homes or use audio-only calls for some care — could go away at the end of the year.

Legislators have signaled bipartisan support for the flexibilities, but some questions about cost, quality and access still linger. At a House subcommittee hearing earlier this month, members and witnesses discussed what types of care is best suited to telehealth, how much to pay providers for virtual care and how to ensure patients won’t lose access to in-person options.

The latest study aims to address some concerns from policymakers, the authors wrote. The research assigned Medicare patients to health systems according to care patterns in 2019, and then divided those providers into high and low telehealth use based on their adoption in 2020. They then looked at outcomes in 2021 and 2022.

In the post-pandemic period, patients at health systems in the highest quartile of telehealth use had an increase of 0.21 outpatient visits per patient per year. They experienced a decrease of 14.4 annual non-COVID emergency department visits per 1,000 patients per year, and a $248 increase in per patient per year spending. 

The spending increase was largely driven by inpatient admissions and pharmaceutical costs, and offset by decreases in outpatient hospital spending, the research found. 

Patients at high-telemedicine use systems were also more adherent to medications like metformin, a diabetes drug, and statins, usually used to lower cholesterol. 

The relatively small increase in outpatient visits was “somewhat surprising,” researchers wrote. Providers at health systems with the highest levels of telehealth adoption may have had limited capacity to provide many more visits, or there could have been less demand because of technological issues or concerns about quality. 

“Moving forward, it will be important to continue monitoring telemedicine’s impact on quality and spending,” the study’s authors wrote. “The effects of telemedicine on quality and spending could change as technology improves, health systems optimize telemedicine services, or patient demand grows.”