Telehealth does not increase low value care and, in some cases, can even reduce unnecessary tests and procedures, according to a new study published in Open JAMA Network.¹

This study is the first to analyze the relationship between telehealth and low-value care in primary care settings. It differs from previous research focused on high- and low-value care during the COVID-19 pandemic, which found increased telehealth use associated with more hospitalizations for outpatient-sensitive conditions. Unlike those studies, this research covers a longer time period with fewer COVID-19-related illnesses, helping to better reflect typical health behaviors. The researchers, including A. Mark Fendrick, MD, co-editor of The American Journal of Managed Care^®said the new data can help and reassure policymakers as they consider future Medicare telehealth policies and their broader impact on health care.

“Our results are reassuring in the context of current telehealth policy decisions, as there is concern that telehealth may increase access to care to a degree that leads to unnecessary visits and wasted screening or testing. diagnosis,” lead author Terrence Liu, MD, MS, primary care physician in the University of Michigan Health Division of General Medicine and national clinician scholar at the Institute for Health Care Policy and Innovation from the University of Michigan, said in a statement. press release.²

This retrospective cohort study analyzed Medicare fee-for-service claims from 2019 to 2022 to assess the impact of telehealth on low-value care among Michigan residents.¹ Practices were categorized into tertiles of high, medium, and low telehealth use, and primary outcomes included changes in rates of low-value care in office-based, laboratory-based, imaging-based services and mixed modalities. Using risk-adjusted rates, researchers compared rates of low-value services in these groups, including services such as prostate-specific antigen testing for men over 75 and Cervical cancer screening for women over 65 years of age, to evaluate the potential effects of telehealth on unnecessary procedures in primary care.

Researchers analyzed data from 577,928 beneficiaries (female, 57%; white, 87%; average age, 76 years) assigned to 2,552 primary care practices in 2022. Telehealth use varied by practice, with higher adoption of telehealth observed in urban practices. Specifically, 43% of beneficiaries in low-telehealth-use practices lived in rural areas, compared to 16% in high-telehealth-use practices.

Telehealth visit rates increased significantly from 2019 to 2022 across all practice tertiles:

• Low: from 7 to 194 visits per 1000 beneficiaries
• Average: from 5 to 654 visits per 1000 beneficiaries
• High: from 13 to 1469 visits per 1000 beneficiaries

In-person visitation rates have decreased:

• Low: from 10,200 to 7,862 visits per 1,000 beneficiaries
• Average: from 12,781 to 11,670 visits per 1000 beneficiaries
• High: from 16,183 to 13,557 visits per 1000 beneficiaries

After adjusting for practice-level characteristics and baseline differences in rates of low-value care, high practice-level telehealth use was linked to lower rates of cervical cancer screening. low-value uterine tests (−2.9 services per 1,000 beneficiaries; 95% CI, −5.3 to −0.4)) and lower rates of low-value thyroid tests (−40 tests per 1 000 beneficiaries; 95% CI, −70 to −9) compared to practices with low use of telehealth. For imaging-based services, CT sinus imaging rates increased across all tertiles, but other imaging rates, such as for uncomplicated headache and low back pain, showed a change minimal.

Researchers attributed the reduction in cervical cancer screening to a decrease in in-person visits, while the drop in thyroid testing could be due to telehealth limiting the use of lab tests. These results suggest that telehealth can help reduce healthcare waste without compromising quality.

This study has limitations, including a focus on certain low-value services and a sample limited to fee-for-service Medicare beneficiaries in Michigan, which may not be generalizable. The use of administrative claims data prevented measurement of overall quality of care, and the use of telehealth was evaluated at the practice level, not for individual outcomes. Additional national research is needed to explore the broader impact of telehealth on low-value care.

“I view telehealth as a way to supplement providers’ usual methods of delivering care, and I would not expect it to necessarily improve the quality of health care or decrease costs by reducing costs alone. low-value care,” Liu said.² “We need to find ways to best integrate telehealth into our current health care delivery system and think about how to reduce low-value care, both in person and in a virtual environment. »

References

1. Liu T, Ellimoottil C, Fendrick AM, Thompson M, Chang CH, McCullough J. Use of telehealth in primary care practice and low-value care services. JAMA Open Network. Published online November 7, 2024. doi:10.1001/jamanetworkopen.2024.45436

2. Does more virtual care mean more low-value care? The study suggests no. Press release. Michigan Medicine – University of Michigan. November 6, 2024. Accessed November 7, 2024.