Study: Telehealth use doesn't increase healthcare utilization

New research in Health Affairs Scholar revealed that total outpatient visits did not increase, but rather declined slightly, among specialty groups with higher telehealth use.

Conducted by University of Michigan (U-M) researchers, the study comes as the virtual care industry faces another telehealth cliff. Pandemic-era telehealth flexibilities that drove telehealth access and adoption are set to expire at the end of the month.

The researchers noted that one of the main concerns surrounding increased telehealth access is that it may cause healthcare utilization to skyrocket without significantly improving quality. Thus, they set out to examine whether increased telehealth adoption was associated with changes in outpatient visit volume.

Using 100% of Medicare FFS claims from Carrier and Outpatient files and Berenson-Eggers Type of Service codes, the researchers conducted an analysis of total outpatient office visit volumes across surgical, non-surgical and behavioral health specialty groups with low, medium and high telehealth adoption. They examined visit volume during pre-pandemic (January 2019 to February 2020) and post-pandemic (January 2021 to June 2024) periods.

The study included 60 million patients across 538 million outpatient office visits over the five-year study period. In the post-pandemic period, telehealth comprised 5.3% of total outpatient office visits for the low telehealth use group, 9.1% for the medium telehealth use group and 43.8% for the high telehealth use group.

Though telehealth adoption varied post-pandemic, all three groups experienced declines in the predicted number of total outpatient office visits. The low telehealth group experienced a 14% drop, the medium telehealth group a 17% decline and the high telehealth group an 18% decrease.

Compared to the low telehealth group, both medium and high telehealth groups saw significantly larger declines post-pandemic, the study noted.

Researchers concluded that the jump in telehealth adoption post-pandemic was not associated with an increase in total outpatient office visits among Medicare beneficiaries. Instead, "telehealth visits appear largely to have served as a substitute for in-person visits," they wrote.

These findings could inform lawmakers' decisions regarding the future of Medicare telehealth flexibilities. These flexibilities, enacted during the COVID-19 public health emergency, drove a significant increase in telehealth use among Medicare fee-for-service patients. However, lawmakers have expressed concerns about their impact on overall healthcare utilization.  

"One of the things that is paralyzing the policy debate is uncertainty and concern about whether covering telehealth in parity with in-person care would be associated with runaway utilization. But we don't see that here," said the study's lead author, James D. Lee, M.D., national clinician scholar at the U-M Institute for Healthcare Policy and Innovation and a clinical instructor in the U-M Medical School, in a press release.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.