- Whether or not telehealth visits result in duplicative care — a hot topic on the Hill as Congress debates future telemedicine regulation — could depend on whether users have acute or chronic conditions, a new study suggests.
- Researchers analyzed data from almost 41 million commercially insured adults, and found patients with acute conditions that had an initial telehealth visit were slightly more likely to have a follow-up encounter, emergency room visit or inpatient admission, compared to those who had an in-person visit.
- However, patients with chronic conditions that had an initial telehealth visit were as or less likely to need follow-up care, than those with an initial in-person visit.
The findings of contrasting patterns of follow-up care puts some guidelines around the big question of whether telemedicine results in additive care, instead of taking the place of an in-person encounter.
The new study published Tuesday in Jama Network Open assesses the association of telehealth with care outcomes, by analyzing data from members of private Blue Cross Blue Shield plans.
Previous research has shown that, in the first year of the pandemic, telehealth made up a large share of ambulatory encounters at the peak of COVID-19 and remained high, even as infections subsided.
Researchers zeroed in on enrollees' ambulatory encounters and care outcomes two weeks after an initial visit from July to December 2020 — a period of more established telehealth use — to assess comparable episodes of care delivered via telehealth versus in-person encounters.
They found telehealth encounters for chronic conditions had similar or lower rates of follow-up to in-person encounters, while telehealth encounters for acute conditions appeared to be more likely to need follow-up compared to in-person encounters.
Follow-up care after a telehealth encounter was substantially more common for acute respiratory infections, but less so for other types of acute conditions, researchers said, suggesting the difference reflects concerns associated with the pandemic.
Research is mixed on whether telemedicine cuts down on care and saves the healthcare system money overall, or results in duplicative visits and additional costs. Some previous studies conducted prior to the pandemic conflict with Tuesday's findings, including a 2017 study from the Rand Corporation that found virtual care increased healthcare utilization and spending in California.
Regulations allowing for broader telehealth payment and access are set to wind down when the COVID-19 public health emergency expires, currently scheduled for mid-July. Congress has enacted a temporary grace period for telehealth flexibilities after the end of the emergency, so regulators have more time to analyze telehealth's impact before lawmakers permanently enshrine new legislation.
Expanding telemedicine access enjoys broad bipartisan support in Congress, though conversations around the modality have petered out as legislators wrestle over further COVID-19 funding, inflation and geopolitical conflicts. A number of bills have been introduced to codify more telehealth protections after COVID-19, including the industry-supported CONNECT for Health Act, which would loosen geographic and originating site restrictions.