Primary Care Telehealth and Patient Utilization, Quality, and Spending in Traditional Medicare
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BACKGROUND: Coverage for telehealth services was expanded during the COVID-19 public health emergency for traditional Medicare (TM) beneficiaries. It is unclear how increased provision of telehealth services is associated with primary care service volume, healthcare spending, or patient outcomes. OBJECTIVE: To examine the impact of a practice's level of primary care telehealth delivery on healthcare utilization, spending, and patient outcomes. DESIGN: Using a difference-in-differences design, this retrospective cohort study compared changes in outcomes from the pre-pandemic period (1/1/2019-12/31/2019) to the post-telehealth expansion period (7/1/2020-12/31/2022) between TM beneficiaries attributed to primary care practices delivering the highest versus lowest quartile of telehealth evaluation and management (E&M) visits during the early-pandemic period (January-June 2020). PARTICIPANTS: A nationally representative 20% random sample of TM beneficiaries between 2019 and 2022. MAIN MEASURES: Outcomes included total and in-person E&M visits; total hospitalizations and ambulatory care-sensitive admissions (ASCAs); total and preventable emergency department (ED) visits; and inpatient, outpatient, and total healthcare spending. KEY RESULTS: The study included 1,238,734 patients (60% attributed to high-telehealth practices). In adjusted analyses, high-telehealth practice attribution was associated with a decrease in in-person E&M visits (-0.86 visits per patient per year; 95% CI, -0.94 to -0.78), an increase in total E&M visits (0.10 visits per patient per year; 95% CI, 0.03 to 0.18), and a modest increase in total ED visits (0.02 visits per patient per year; 95% CI, 0.00 to 0.03) and preventable ED visits (0.01 visits per patient per year; 95% CI, 0.00 to 0.02). There were no significant changes in total hospitalizations, ambulatory care-sensitive admissions, or healthcare spending. CONCLUSIONS: Greater telehealth delivery by primary care practices was associated with a decline in in-person E&M visits and a small net increase in total E&M visits. These changes were not associated with differences in hospitalizations or overall healthcare spending. CLINICAL TRIAL NUMBER: Not applicable.