One major concern surrounding telehealth is the possibility that it could lead to unnecessary tests and scans, which would waste funds and resources. However, a recent study indicates that primary care offices utilizing the most telehealth services did not see a significant increase in low-value care.
By the end of 2024, Congress will make a decision on whether to maintain or alter telehealth regulations or allow them to expire. Although the focus will be on Medicare’s payments for virtual health services, this choice is likely to affect telehealth accessibility for individuals under various health insurance plans.
According to a new analysis from the University of Michigan, lawmakers can be reassured about a common concern regarding telehealth: the idea that virtual consultations might lead to an escalation in unnecessary tests and screenings, thereby squandering financial and medical resources.
The study found that practices with high telehealth usage did not experience a quicker rise in low-value care when compared to those with lower usage rates.
Interestingly, some high-usage practices actually witnessed a more rapid decline in low-value care.
This research, published in JAMA Network Open, investigated eight specific low-value procedures and tests that experts agree aren’t needed for certain patient demographics. These included blood tests for prostate cancer risk in men over 75, CT scans for uncomplicated sinus infections or back pain, Pap smears for cervical cancer screening in women over 65, and colon cancer screenings in individuals over 85.
Despite concerns that low-value care might rise due to the shift to virtual appointments—where doctors can’t perform physical examinations—this study dispelled that notion.
“Our results provide reassurance regarding current telehealth policy discussions, as concerns had been raised about potential increases in unnecessary consultations and wasteful screenings or tests associated with telehealth,” stated lead author Terrence Liu, M.D., M.S., a primary care physician affiliated with U-M Health and the National Clinician Scholar program at the U-M Institute for Healthcare Policy and Innovation.
The research utilized data from nearly 578,000 Michiganders enrolled in traditional Medicare who visited over 2,550 primary care facilities between 2019 and 2022. The clinics were categorized into three groups—high, medium, and low telehealth utilization—based on their billing for virtual consultations in 2022, while accounting for variances in patient volumes.
The study confirmed earlier findings from U-M that also indicated fears regarding an influx of in-person visits for follow-ups prompted by virtual visits were unfounded. The rate of in-person consultations actually decreased during the telehealth period, according to both the previous and this recent research.
Liu and his team focused on the eight specific types of low-value care because they have been identified in prior studies and targeted for reduction by leading medical organizations.
In six out of the eight categories, either the rate of patients receiving such care fell or remained stable between 2019 and 2022, independent of the level of telehealth services provided by the clinics.
However, in two instances—cervical cancer screenings in women over 65 and ongoing blood tests for thyroid hormone in those with hypothyroidism—the medium and high telehealth clinics experienced a more pronounced decline than those with low telehealth utilization.
This recent analysis concentrated on low-value care commonly seen in primary care, using well-established criteria for identifying such care within Medicare records, while also considering the trend of an increasing number of older adults opting for Medicare Advantage instead of traditional Medicare.
While the findings are primarily based on data from Michigan sourced from the Michigan Value Collaborative, Liu and his colleagues plan to replicate the analysis using a broader national sample of Medicare data.
Liu collaborated with senior author Chad Ellimoottil, M.D., M.S., who manages virtual care for the U-M Medical School’s faculty practice, known as the Michigan Medical Group. A. Mark Fendrick, M.D., director of the U-M Center for Value Based Insurance Design, co-authored the study.
“I see telehealth as a complementary tool for healthcare providers, and I don’t think it alone will enhance care quality or lower costs by diminishing low-value care,” Liu remarked. “We need to explore optimal ways to integrate telehealth into the existing healthcare framework and address how to minimize low-value care in both in-person and virtual contexts.”
“These significant findings imply that whether health recommendations originate from an in-person or virtual consultation, factors like access to care, out-of-pocket expenses, and the time and effort patients must invest in both necessary and unnecessary medical services significantly influence their utilization,” Fendrick stated.
Liu, Ellimoottil, Fendrick, and co-authors Michael Thompson, Ph.D., Chiang-Hua Chang, Ph.D., and Jeffrey McCullough, Ph.D., are all associated with the U-M Institute for Healthcare Policy and Innovation.
