Telehealth does not boost low-value care, study finds

New research reveals that telehealth was associated with slightly lower use of, and spending on, certain low-value tests, which indicates that it could help cut unnecessary healthcare spending.

Published in JAMA Internal Medicine, the study examined whether telehealth contributes to unnecessary healthcare spending by increasing the utilization of low-value care services. Low-value care services include medical tests and procedures that provide little to no benefit to patients and may cause direct harm.

The study authors noted that understanding whether telehealth influences low-value care utilization is critical as telehealth continues to be widely used. Further, Congress is yet to decide whether to extend pandemic-era telehealth flexibilities beyond its current expiration deadline of March 31, 2025.

"In theory, widespread adoption of telemedicine post-pandemic may influence low-value testing -- such as Pap smears and prostate cancer screenings in older adults, and imaging scans for straightforward cases of low back pain," said study lead author Ishani Ganguli, MD, a primary care physician at Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School, in a press release. "But there was very limited evidence on this. We wanted to look at this question at a national level because there is active policy debate about whether and how Medicare should continue telemedicine coverage, hinging in large part on how telemedicine impacts care quality and spending."

The researchers used 2019-2022 fee-for-service Medicare claims data to divide U.S. health systems into quartiles based on their telehealth adoption in 2020. They then attributed continuously enrolled beneficiaries to health systems with high or low telehealth adoption.

The research team calculated total visits per beneficiary in each calendar year and then examined the use of 20 low-value tests. These included screening tests, such as screening electrocardiograms; preoperative tests, like metabolic panels; chronic condition management tests, like stress testing for stable coronary artery disease; and acute diagnostic tests, like imaging for uncomplicated low back pain.

The study included 1.38 million Medicare beneficiaries receiving care at 143 high-telehealth adoption systems and 999,051 at 143 low-adoption systems.

Researchers found that compared to Medicare patients receiving care in low-adoption health systems, those in high-adoption systems had slightly higher rates of total virtual and in-person visits but lower use rates for seven low-value tests, including cervical cancer screening, preoperative complete blood cell counts and imaging for uncomplicated low back pain.

The two groups had no statistically significant differences in usage for the other 13 tests.

Further, overall spending on low-value care between the groups was similar. However, there were significant decreases in spending per beneficiary for two low-value tests among patients at high-adoption systems compared with those at low-adoption systems.

The study shows a 27% drop in spending on cervical cancer screening and a 7% decrease in spending on preoperative blood cell counts among patients at systems with high telehealth adoption.

According to the researchers, the study results show that despite telehealth increasing access to healthcare visits, it may also curb spending on low-value care.

"As CMS and private payers evaluate telemedicine reimbursement policies, such as the extension of Medicare's temporary allowance of broad telemedicine coverage beyond 2024, these results suggest potential benefits of telemedicine and mitigate concerns about telemedicine contributing to increased Medicare spending," they concluded.

However, prior research has shown a modest increase in healthcare spending linked to telehealth.

A study published in 2024 found that although telehealth was connected to improvements in some healthcare utilization and quality measures, it was associated with a 1.6% increase in healthcare spending. The research, which included 5.51 million Medicare beneficiaries, shows spending at health systems with high telehealth use increased by $248 in 2021-22, compared to spending at health systems with low telehealth use.

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