Telehealth generally didn't lead to duplicative care in late 2020, according to a study published Tuesday.
Patients treated for most acute conditions via telehealth were as likely or slightly more likely to need a follow-up visit as those who sought in-person care to start, the study in JAMA Network Open found. Telehealth patients with chronic conditions were less likely to need follow-up care.
Telehealth patients with acute respiratory infections were more likely to require a follow-up visit than in-person patients, but this could reflect COVID-19-related concerns, the researchers said.
Policymakers are focusing on the efficacy of telehealth as they contend with how to move forward with related policies after the COVID-19 public health emergency.
The latest study conflicted with earlier research that found telehealth visits spurred duplicative care. Thirty-percent of telehealth visits lead to in-person care, according to a survey of more than 4,000 people from commercial real estate firm JLL released in March. A 2017 study from the RAND Corporation also found that telehealth increased healthcare utilization and spending in California prior to the COVID-19 pandemic.
"Telehealthcare is comparable to in-person care and it really is not a duplication of the service," said Dr. Elham Hatef, an assistant professor at Johns Hopkins University and one of the researchers on the latest study. "That might help policymakers to consider the continuation of insurance coverage for telehealth services."
The study looked at data from 40.7 million commercially insured adults on Blue Cross and Blue Shield Association plans between July 1 and December 31, 2020.
Congress allowed Medicare to cover expanded telehealth services for at least 151 days after the end of the COVID-19 public health emergency, which will expire no earlier than mid-July. The short-term continuation offers more time for research on telehealth's impact before lawmakers decide whether to make flexibilities permanent.
The JAMA study focuses on commercially insured patients, so its findings aren't directly transferable to Medicare beneficiaries, who tend to be older and sicker. Researchers need to look specifically into follow-up care trends for Medicare and Medicaid beneficiaries, Hatef said.
But the finding that telehealth resulted in a lower chance of follow-up care for patients with chronic conditions is promising for Medicare beneficiaries, said Krista Drobac, executive director of telehealth policy advocacy group Alliance for Connected Care. About 30% of traditional Medicare beneficiaries have six or more chronic conditions, according to the Commonwealth Fund.
"What we're most interested in is impact on Medicare. If the researchers found lower rates of follow up for chronic conditions, that might mean that telehealth in Medicare will yield lower overall follow up because more seniors have chronic conditions," Drobac said.
Patients in the study cohort with chronic conditions who used telehealth seemed to be slightly sicker overall than in-person patients, Hatef said.
The next step is to study clinical outcomes for different subpopulations of patients using telehealth during the pandemic, she said. Studying follow-up visit rates after December 2020 will also be important, as outcomes may have changed after the COVID-19 vaccine became available, Hatef said.
Telehealth conversations have stalled in Congress since lawmakers passed the 151-day extension in March. Sen. Joe Manchin (D-W.Va.) indicated Tuesday that a bill he co-authored is gaining traction. It would make certain Medicare telehealth flexibilities permanent after the public health emergency.
"We're moving on that again, but it's all intertwined with internet connectivity so we have to move in that direction," Manchin said Tuesday at the American Hospital Association's annual meeting in Washington.