Low-value medical care—tests and procedures that offer minimal to no benefit to patients—is a significant contributor to excessive healthcare spending. It also inflicts direct harm as well as cascading effects on patients. A research team from Mass General Brigham, along with their collaborators, has found that telemedicine might help in reducing the usage of low-value tests. Their work is published in JAMA Internal Medicine.
“In theory,” said lead author Ishani Ganguli, MD, MPH, “widespread adoption of telemedicine post-pandemic could influence low-value testing such as Pap smears and prostate cancer screenings among older adults, along with imaging scans for uncomplicated cases of lower back pain.” However, there was very little evidence to support this. The team decided to explore the question at a national level due to active policy debates about whether Medicare should continue covering telemedicine services based on their impact on care quality and spending.
Ganguli and her colleagues used a quasi-experimental study design. They analyzed fee-for-service Medicare claims data from over 2 million beneficiaries who received care in health systems across the United States that either did or did not adopt telemedicine extensively during the COVID-19 pandemic period, which included both pre-pandemic and post-pandemic times.
Comparing patients from high-telemedicine systems to those from low-telemedicine systems, they found slightly higher rates of total visits (both virtual and in-person) in high-telemedicine environments. However, there was a lower usage of 7 out of 20 low-value tests: cervical cancer screening; screening electrocardiograms; screening metabolic panels; preoperative complete blood cell counts; preoperative metabolic panels; total or free triiodothyronine level testing for hypothyroidism, and imaging for uncomplicated low back pain. There were no significant differences observed in the other 13 tests.
In terms of spending, patients from high-telemedicine systems spent less per beneficiary on visits but not necessarily lower overall in low-value test expenditures out of the total 20 reviewed.
The findings indicate that while telemedicine can reduce barriers to accessing care, it may also discourage clinicians and patients from conducting some low-value tests. This is particularly true for tests like electrocardiograms and blood counts which are typically carried out on-site during or right after an office visit.
These results provide additional reassurance to policymakers that extending telemedicine coverage could potentially lead to benefits such as reduced usage and spending on a variety of low-value tests. “We hope our study can inform future policies about the role of telemedicine in healthcare, emphasizing both its potential advantages and areas where further investigation might be needed,” Ganguli added.
