Telemedicine, or non-in-person health care, has been around for quite a while, but its use skyrocketed during the epidemic. Among other payers, Medicare greatly expanded the use of telemedicine and has left that expansion in place. There was a belief that tele-visits should be cheaper to provide and were more convenient for patients and wouldn’t necessarily be of lower quality. Those beliefs are now being tested by research. As usual, my highly skeptical nature anticipates that those benefits would be overstated. A study in Health Affairs examined the effect of telemedicine on Medicare spending, use of services and quality from 2019 to 2022. (HA Study)
Patients who were the heaviest users of telemedicine were compared with those who were low users. Telemedicine users had lower ER use. They had somewhat higher total use of outpatient services. There was no change in hospitalization rate. Total spending increased by $250 a year per patient for the higher users. In terms of quality, there was no clear difference in preventative care received. There was increased adherence to cholesterol-lowering medicines and a common medicine for diabetes. So it appears that telemedicine doesn’t result in a massive increase in health care utilization, but also doesn’t reduce hospitalizations. It has a minor impact on some quality measures. It doesn’t reduce spending, but doesn’t increase it by much.
Some medical care is better than none, but not having a physical examination as part of a visit is like a famous physician once said and I paraphrase: examining a patient without touching them is like trying to go to sea without getting on the boat.
FWIW – I had a few follow up telemed conferences (via zoom or some variation of zoom). I personally found that method of communication very ineffective. Far too much information was lost or poorly conveyed with the impersonal nature of telemed