Association Between Telehealth Use and Downstream 30-Day Medicare Spending
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Objectives
The objective of this study was to investigate whether healthcare visits initiated by telehealth had higher or lower 30-day spending compared to in-person-initiated visits. The study compared the overall spending, rates of return visits, laboratory tests, and imaging procedures within 30 days for Medicare fee-for-service patients who underwent in-person and telehealth evaluations between July 1, 2020 and December 31, 2022.
Study Design
A large-scale retrospective cohort study using propensity score matching.
Methods
This study included 100% of Medicare fee-for-service beneficiaries who are aged >65 years while excluding those with Medicare Advantage coverage and those without continuous Medicare Parts A and B. We identified patients with no prior visits and 30-day episodes of care initiated by outpatient telehealth or in-person visits from July 1, 2020 through December 31, 2022. We then compared adjusted 30-day total Medicare spending, rates of return visits, laboratory tests, and imaging utilization between propensity-matched index visits initiated by telehealth versus in-person.
Results
Telehealth-initiated visits were associated with lower 30-day spending ($260 vs. $342; net: −$82), though return visit rates were higher for telehealth (16.1% vs. 14.1%). Both lab test rates (7.8% vs. 24.2%) and imaging rates (3.5% vs 7.8%) were lower for telehealth-initiated episodes compared to in-person-initiated episodes.
Conclusions
Telehealth-initiated episodes of care were associated with lower 30-day Medicare spending and reduced utilization of labs and imaging. These findings suggest that telehealth, when used as a substitute for office visits, may reduce overall Medicare spending.
