Association Between Telehealth Use and 30-day Medicare Spending
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Importance
Despite the widespread use of telehealth among Medicare beneficiaries secondary to the COVID-19 pandemic, few studies have evaluated telehealth’s impact on downstream spending.
Objective
This retrospective cohort study compares 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.
Design
A large-scale retrospective cohort study using propensity score matching
Setting
Patients with no prior visits and 30-day episodes of care initiated by telehealth or in-person visits from July 1, 2020 through December 31, 2022.
Participants
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.
Exposure(s)
Comparison of index visits initiated by telehealth versus in-person visits.
Primary outcome
Adjusted 30-day total spending.
Secondary outcomes
30-day rates of return visits, laboratory tests, and imaging.
Results
The study included 30,079,958 participants with 36,709,528 and 429,891,125 episodes initiated by telehealth and in-person visits, respectively. The mean age was 76 for telehealth and 75 years for in-person. 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 care episodes compared to in-person-initiated care episodes.
Conclusions and Relevance
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.
