Primary Care Telehealth and Patient Utilization, Quality, and Spending in Traditional Medicare.

backgroundCoverage 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.

objectiveTo examine the impact of a practice's level of primary care telehealth delivery on healthcare utilization, spending, and patient outcomes.

designUsing 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).

participantsA 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

resultsThe 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.

conclusionsGreater 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.