Telehealth Does Not Increase Low-Value Care, Study Finds

Telehealth does not increase low-value care and, in some cases, may even reduce unnecessary tests and procedures, according to a new study published in JAMA Network Open.¹

This study is the first to analyze telehealth's relationship with low-value care in primary care settings. It differs from prior research that focused on high- and low-value care during the COVID-19 pandemic, which found increased telehealth use associated with more hospitalizations for ambulatory care–sensitive conditions. Unlike those studies, this research spans a longer period with fewer COVID-19–related illnesses, allowing for a better reflection of typical health behaviors. The researchers, who include A. Mark Fendrick, MD, co–editor in chief of The American Journal of Managed Care^®, said the new data can aid and reassure policy makers as they consider future Medicare telehealth policies and their broader impact on health care.

“Our findings are reassuring in the context of current telehealth policy decisions, because there has been concern that telehealth might be increasing access to care to a degree that leads to unnecessary visits and wasteful screening or diagnostic testing,” lead author Terrence Liu, MD, MS, a primary care physician in the Division of General Medicine at University of Michigan Health and National Clinician Scholar at the University of Michigan Institute for Healthcare Policy and Innovation, said in a press release.²

This retrospective cohort study analyzed Medicare fee-for-service claims from 2019 to 2022 to assess the impact of telehealth on low-value care among Michigan residents.¹ Practices were categorized into high, medium, and low telehealth usage tertiles, and primary outcomes included changes in low-value care rates in office-based, laboratory-based, imaging-based, and mixed-modality services. Using risk-adjusted rates, researchers compared low-value service rates across these groups, including services like prostate-specific antigen tests for men older than 75 years and cervical cancer screening for women older than 65 years, to evaluate the potential effects of telehealth on unnecessary procedures in primary care.

Researchers analyzed data from 577,928 beneficiaries (women, 57%; White, 87%; mean age, 76 years) attributed to 2552 primary care practices in 2022. Telehealth use varied by practice, with higher telehealth adoption seen in urban practices. Specifically, 43% of beneficiaries in low-telehealth-use practices lived in rural areas, compared with 16% in high-telehealth-use practices.

Telehealth visit rates increased significantly from 2019 to 2022 across all practice tertiles:

• Low: from 7 to 194 visits per 1000 beneficiaries
• Medium: from 5 to 654 visits per 1000 beneficiaries
• High: from 13 to 1469 visits per 1000 beneficiaries

In-person visit rates declined:

• Low: from 10,200 to 7862 visits per 1000 beneficiaries
• Medium: from 12,781 to 11,670 visits per 1000 beneficiaries
• High: from 16,183 to 13,557 visits per 1000 beneficiaries

After adjusting for practice-level characteristics and baseline differences in low-value care rates, high practice-level telehealth use was linked to lower rates of low-value cervical cancer screening (−2.9 services per 1000 beneficiaries; 95% CI, −5.3 to −0.4)) and lower rates of low-value thyroid testing (−40 tests per 1000 beneficiaries; 95% CI, −70 to −9) compared with low-telehealth-use practices. For imaging-based services, CT sinus imaging rates increased across all tertiles, but other imaging rates, such as for uncomplicated headaches and low back pain, showed minimal change.

Researchers attributed the reduction in cervical cancer screening to fewer in-person visits, while the decline in thyroid testing may have been due to telehealth limiting the use of laboratory tests. These findings suggest telehealth can help reduce wasteful care without compromising quality.

This study has limitations, including a focus on select low-value services and a sample limited to Medicare fee-for-service beneficiaries in Michigan, which may not be generalizable. The use of administrative claims data prevented measurement of overall care quality, and telehealth use was assessed at the practice level, not for individual outcomes. Further national research is needed to explore the broader impact of telehealth on low-value care.

“I view telehealth as a way to supplement providers’ usual ways of delivering care, and wouldn’t expect it to necessarily improve health care quality or decrease cost by reducing low-value care on its own,” said Liu.² “We need to find ways to best integrate telehealth into our current healthcare delivery system and think of how to reduce low-value care in both the in-person and virtual setting.”

References

1. Liu T, Ellimoottil C, Fendrick AM, Thompson M, Chang CH, McCullough J. Primary care practice telehealth use and low-value care services. JAMA Netw Open. Published online November 7, 2024. doi:10.1001/jamanetworkopen.2024.45436

2. Does more virtual care mean more low-value care? Study suggests no. News release. Michigan Medicine - University of Michigan. November 6, 2024. Accessed November 7, 2024. https://www.newswise.com/articles/does-more-virtual-care-mean-more-low-value-care-study-suggests-no