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Diving brief:
- Increased telehealth use among Medicare beneficiaries is linked to some quality improvements and relatively small increases in health care spending — findings that could support maintaining regulatory flexibilities for virtual care, a study suggests. study published Wednesday in health matters.
- Medicare patients who received care in health systems with high levels of telehealth adoption experienced modest increases in office visits, continuity of care, and medication adherence, as well as decreased emergency department visits compared to low-utilization telehealth systems. This group also experienced a 1.6% increase in health care spending.
- The quality and cost findings mean it may be difficult to defend restricting payment for telehealth in Medicare, the researchers wrote. Some telehealth flexibilities during a pandemic are scheduled to expire at the end of this year without congressional action.
Dive overview:
Use of telehealth skyrocketed during the COVID-19 pandemicaided by relaxed rules aimed at preserving access to care during the public health emergency.
Some of these changes have become permanent, but other flexibilities — such as allowing Medicare patients to have telehealth at home or use audio-only calls for certain care — could disappear at the end of the year.
The legislators have reported bipartisan support for flexibilities, but a few questions about cost, quality and access linger again. At a House subcommittee hearing earlier this month, members and witnesses discussed what types of care are best suited for telehealth, how much to pay providers for virtual care and how much way to ensure patients will not lose access to in-person options.
The latest study aims to address some concerns of policymakers, the authors write. The research assigned Medicare patients to health systems by care models in 2019, then divided those providers into high and low telehealth use based on their adoption in 2020. They then looked at results in 2021 and 2022.
During the post-pandemic period, patients in health systems in the highest quartile of telehealth use experienced 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 spending per patient per year.
The increase in spending is largely driven by inpatient admissions and pharmaceutical costs, and offset by a decrease in outpatient hospital spending, the research shows.
Patients in systems with high telemedicine use were also more adherent to medications like metformin, a diabetes drug, and statins, typically used to lower cholesterol.
The relatively small increase in outpatient visits was “somewhat surprising,” the researchers wrote. Providers in health systems with the highest levels of telehealth adoption may have had limited capacity to provide many more visits, or demand might have been less due to technology issues or concerns about quality .
“Going forward, it will be important to continue to monitor the impact of telemedicine on quality and spending,” the study authors write. “The effects of telemedicine on quality and spending could change as technology improves, health systems optimize telemedicine services, or patient demand increases. »