The COVID-19 pandemic brought about a significant shift in healthcare delivery, compelling many healthcare providers to adopt telehealth as a vital alternative to traditional in-person consultations. This rapid expansion was enabled by regulatory flexibilities, which raised concerns about the potential for increased low-value care—unnecessary tests and procedures that offer little to no benefit to patients and lead to wasteful healthcare practices. A recent study published in JAMA Network Open delves into whether telehealth has indeed led to an increase in low-value care within primary care settings, shedding light on a critical aspect of modern healthcare.
The Study’s Scope and Methodology
To address these pressing concerns, researchers from the University of Michigan and Veterans Affairs Center for Clinical Management Research conducted a comprehensive retrospective cohort analysis. They utilized a robust dataset consisting of Medicare fee-for-service claims spanning January 1, 2019, to December 31, 2022. This time frame encompasses both pre-pandemic and post-pandemic periods, providing a comparative basis for their analysis of the impact of telehealth on low-value care services. Primary care practices were categorized into three different groups based on their telehealth usage rates in 2022: low, medium, and high telehealth use. This stratification enabled the researchers to assess the effects of varying levels of telehealth adoption.
The sample included a representative population of 577,928 beneficiaries attributed to 2,552 primary care practices, forming a strong foundation for the study. Researchers focused on eight specific low-value care services relevant to primary care. These services were categorized into office-based, laboratory-based, imaging-based, and mixed-modality services. The primary outcome of interest was the difference in risk-adjusted rates of these low-value care services between 2019 and 2022. This rigorous methodological approach aimed to uncover whether the adoption of telehealth has influenced the delivery of these services, either positively or negatively.
Key Findings on Low-Value Care Services
The findings of the study provided some fascinating insights. The primary outcome revealed that, overall, the rates of six out of the eight low-value services either decreased or stayed consistent between the pre-pandemic and post-pandemic periods. This suggests that the adoption of telehealth did not lead to an across-the-board increase in low-value care services. Notably, cervical cancer screening in women older than 65 and colorectal cancer screenings in adults older than 85 decreased across all practices, irrespective of their telehealth usage levels.
These results indicate that the downward trend in certain low-value services was not significantly influenced by the level of telehealth adoption, hinting at broader improvements in primary care practices. The study also highlighted some variations in laboratory-based and imaging-based low-value care services. For instance, rates for specific low-value services like vitamin D testing and CT sinus imaging either increased or remained stable across the board. Conversely, services such as low-value thyroid testing and head imaging for uncomplicated headaches experienced a decrease during the study period.
Variations in Laboratory and Imaging-Based Services
The study further revealed that practices with medium- and high-level telehealth use saw more significant reductions in specific low-value services compared to those with low telehealth adoption. Importantly, practices with higher telehealth utilization experienced sharper declines in cervical cancer screening for women over 65 and ongoing blood monitoring for thyroid hormone in individuals with hypothyroidism. This suggests that telehealth, when effectively integrated, may contribute to more judicious use of certain low-value care services.
This finding is particularly interesting as it counters the assumption that telehealth could inherently lead to more low-value care due to its remote nature. Rather, the data indicates that higher telehealth adoption may, in some cases, facilitate more efficient and focused care delivery. These trends were consistent across different types of primary care practices, highlighting the potential of telehealth to enhance care quality while minimizing unnecessary procedures.
Implications for Telehealth Policy
The study’s findings arrive at a crucial juncture, as legislative bodies are actively debating the future of telehealth policies. The regulatory flexibilities that significantly expanded access to telehealth during the pandemic are currently set to expire at the end of the year unless extended by congressional action. Various stakeholders within the telehealth industry are urging Congress to prolong these flexibilities to ensure ongoing access to telehealth services, which have proven valuable during the pandemic.
An amended version of the bipartisan Telehealth Modernization Act of 2024 has recently advanced out of key House committees, proposing to extend these telehealth flexibilities for another two years. The results of this study provide essential evidence for policymakers, suggesting that telehealth does not increase the provision of low-value care services and should continue to be integrated as a core component of primary care practice. This evidence is timely and critical, reinforcing the argument for maintaining and expanding telehealth services.
Expert Insights and Future Directions
The COVID-19 pandemic has significantly transformed healthcare delivery, pushing many providers to adopt telehealth as a crucial alternative to traditional in-person visits. This swift expansion was facilitated by regulatory flexibilities, which have sparked concerns about the potential for increased low-value care—such as unnecessary tests and procedures that provide little or no benefit to patients, ultimately leading to wasteful healthcare practices. A recent study published in JAMA Network Open investigates whether telehealth has indeed contributed to a rise in low-value care within primary care settings. This research is pivotal as it explores an essential aspect of contemporary healthcare, aiming to understand the implications of telehealth’s rapid growth and its effect on the quality and efficiency of patient care. The findings could inform future policies and practices, ensuring that telehealth is implemented in ways that maximize benefits while minimizing any drawbacks.
