Telemedicine may help reduce use of unnecessary health tests

"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 low back pain," said lead author Ishani Ganguli, MD, MPH, of 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. "But there was very limited evidence on this. We wanted to look at this question at a national level because there is active policy debate about whether and how Medicare should continue telemedicine coverage, hinging in large part on how telemedicine impacts care quality and spending."

Using a quasi-experimental study design, Ganguli and her colleagues analyzed 2019-2022 fee-for-service Medicare claims data from more than 2 million beneficiaries who received their care in health systems across the United States that either did or did not adopt telemedicine at high rates during the COVID-19 pandemic. This timeframe encompassed the time before and after telemedicine use skyrocketed with the pandemic.

Compared to patients in low-telemedicine systems, patients in high-telemedicine systems had slightly higher rates of total visits (including virtual or in-person) and lower use of 7 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 in other tests. Those in high-telemedicine systems had lower spending on visits per beneficiary and on 2 of 20 low-value tests, but no differences in low-value spending overall.

The findings suggest that while virtual options may reduce barriers to care, telemedicine may also deter clinicians and patients from completing some low-value tests, especially tests like electrocardiograms and blood counts that would be done on-site during or just after an office visit.

"These findings offer further reassurance to policymakers that extending telemedicine coverage may carry benefits like lower use and spending on a number of low-value tests," said Ganguli.