Low-value care—medical tests and procedures that provide little to no benefit to patients—is a significant contributor to excessive medical spending and both direct and indirect harm. A study by researchers from Mass General Brigham, along with their collaborators, has indicated that telemedicine could help reduce the use of these low-value tests. The research is published in JAMA Internal Medicine.
“In theory, widespread adoption of telemedicine post-pandemic may influence low-value testing—such as Pap smears and prostate cancer screenings in older adults, and imaging scans for straightforward cases of lower back pain,” explained lead author Ishani Ganguli, MD, MPH. Dr. Ganguli is from the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, a founding member of Mass General Brigham, and an Associate Professor of Medicine at Harvard Medical School.
However, there was limited evidence supporting this theory until now. The team wanted to conduct a national-level analysis due to ongoing policy debates about Medicare’s continued telemedicine coverage. These debates hinge on the impacts of telemedicine on care quality and spending.
The researchers used a quasi-experimental study design, analyzing 2019–2022 fee-for-service Medicare claims data from more than two million beneficiaries across various U.S. health systems that either did or didn’t adopt telemedicine at high rates during the COVID-19 pandemic. This period covered both pre-pandemic and post-pandemic usage spikes in telemedicine.
Compared to patients in low-telemedicine systems, those in high-telemedicine systems had slightly higher rates of total visits (both virtual and in-person) but lower use of seven out of 20 low-value tests: cervical cancer screening, screening electrocardiograms, metabolic panel testing for blood sugar levels, preoperative complete blood cell counts before surgery, metabolic panel testing prior to operations, total or free triiodothyronine level testing for hypothyroidism management, and imaging scans for uncomplicated lower back pain. No significant differences were observed in other tests.
Patients receiving care from high-telemedicine systems also experienced reduced spending on visits per beneficiary and two out of 20 low-value tests, but there was no overall difference in total low-value test spending across both groups.
The findings suggest that while telemedicine might reduce barriers to accessing healthcare services, it may also influence clinicians and patients to avoid completing certain low-value tests. This includes on-site procedures like electrocardiograms and blood counts that typically occur during or shortly after an office visit. These results provide policymakers further assurance that extending telemedicine coverage could lead to decreased use and spending on several low-value tests.
