Telemedicine Adoption, US Ambulatory Visits, and Total Medical Spending, 2019-2023.

Importance: Telemedicine is now widely used, stimulated by pandemic-era expansion rules and payment parity to in-person visits. Lawmakers continue to consider how to revise existing policies because of uncertainty about the potential for telemedicine to increase utilization and spending. Objective: To quantify the association between telemedicine adoption and visits and spending. Design, Setting, and Participants: This cohort study used multipayer medical claims data from MedInsight's research database for a national sample of adults continuously enrolled in Medicare fee-for-service, Medicare Advantage, dual-eligible, Medicaid, or commercial insurance, from January 1, 2019, to October 31, 2023. Data were analyzed from April 30, 2024, to February 10, 2026. Exposure: Regional telemedicine adoption (measured at the hospital referral region [HRR] level). Main Outcomes and Measures: The primary outcomes were (1) total combined telemedicine and in-person ambulatory visits (primary care, specialist, and preventive screening visits), and (2) total combined per-member-per-month spending on professional, inpatient, facility outpatient, prescription drug, and ancillary payments. By use of difference-in-differences analyses on visit-level and spending-level changes before (January 1, 2019, to December 31, 2019) vs after (January 1, 2021, to October 31, 2023) telemedicine expansion in high-telemedicine vs low-telemedicine adoption quintiles (measured at the HRR level), age-adjusted, sex-adjusted, and diagnosis-adjusted Poisson regressions were estimated, accounting for repeated measurements over time. Analysis was also stratified by urbanicity, payer, and Centers for Disease Control and Prevention Social Vulnerability Index quintiles to explore heterogeneous associations. Results: The sample included 3.04 million US individuals (mean [SD] age, 54.2 [17.2] years; 55.7% female) who utilized 120 million visits and incurred $178.4 billion in spending during 2019 to 2023. In 2019, the mean (SD) visit rate was 0.66 (0.035), and the mean (SD) spending rate was $774.59 ($36.78) per-member-per-month. Overall, point estimates suggested high-adopting areas had 2.4% (95% CI, -8.1% to 3.6%) fewer visits and 0.5% (95% CI, -13.1% to 13.9%) lower spending; however, 95% CIs crossed the null. Similarly, point estimates varied across subgroups but none achieved statistical significance: there were 4.4% (95% CI, -11.2% to 3.0%) fewer visits and 2.3% (95% CI, -18.9% to 17.8%) lower spending among urban populations, 2.5% (95% CI, -12.9% to 8.0%) lower spending for Medicaid-insured individuals, 5.3% (95% CI, -47.1% to 66.2%) lower spending for dual-eligible individuals, 3.0% (95% CI, -9.2% to 3.5%) lower spending for Medicare Advantage-insured individuals, and 1.5% (95% CI, -19.1% to 19.8%) lower spending among the most socially vulnerable populations. Conversely, point estimates suggested 3.4% (95% CI, -4.9% to 12.5%) greater visits and 3.8% (95% CI, -12.2% to 21.4%) higher spending in rural areas, 1.1% (95% CI, -12.8% to 17.3%) higher spending for commercially insured individuals, 1.0% (95% CI, -7.1% to 11.5%) higher spending for Medicare fee-for-service-insured individuals, and 4.5% (95% CI, -12.7% to 23.1%) higher spending among the least socially vulnerable groups. All 95% CIs crossed the null. Conclusions and Relevance: Nationwide telemedicine adoption was not significantly associated with changes in visits or spending, either overall or when stratified by urbanicity, payer type, or area-level social vulnerability, thus easing concerns about large utilization and spending increases from telemedicine expansion.