Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.8354 Dr. Ishani Ganguli et al.
Points
- This cohort study analyzed how telemedicine adoption affected low-value tests and healthcare spending among 2.38 million fee-for-service Medicare beneficiaries across 286 U.S. health systems from 2019 to 2022.
- Beneficiaries in high-telemedicine-adopting systems slightly increased total visits (0.12 more visits per beneficiary; 95% CI, 0.03 to 0.21).
- High-telemedicine adoption was associated with decreased use of 7 out of 20 observed low-value tests, including cervical cancer screening (−0.45 pp), screening electrocardiograms (−1.30 pp), and imaging for uncomplicated low back pain (−1.66 pp).
- High telemedicine adoption correlated with reduced spending on visits (−$47.87 per beneficiary; 95% CI, −$86.85 to −$8.88), alongside some reductions in spending on low-value tests.
- Telemedicine was linked to modest reductions in unnecessary tests and lower healthcare spending, though its impact on low-value spending was limited, warranting further investigation.
Summary
This cohort study analyzed the relationship between telemedicine adoption and the use of low-value tests among fee-for-service Medicare beneficiaries. The study included 2,381,084 Medicare beneficiaries across 286 U.S. health systems, which were categorized into quartiles based on their 2020 telemedicine adoption rates. The analysis used difference-in-differences (DiD) methodology, comparing beneficiaries in high-telemedicine-adopting systems to those in low-telemedicine-adopting systems from 2019 to 2022. The study aimed to evaluate telemedicine’s impact on the use of low-value tests and overall healthcare spending.
The results indicated that beneficiaries in high-telemedicine systems slightly increased total visits (DiD of 0.12 visits per beneficiary; 95% CI, 0.03 to 0.21) but showed modest decreases in the use of 7 of the 20 observed low-value tests. These tests included cervical cancer screening (DiD: −0.45 percentage points [pp]; 95% CI, −0.72 to −0.17 pp), screening electrocardiograms (DiD: −1.30 pp; 95% CI, −1.96 to −0.65 pp), and imaging for uncomplicated low back pain (DiD: −1.66 pp; 95% CI, −2.35 to −0.98 pp), among others. Additionally, spending on visits was significantly lower for those in high-telemedicine systems (−$47.87 per beneficiary; 95% CI, −$86.85 to −$8.88), with reductions in spending on some low-value tests, though no overall change in low-value spending was observed.
The study’s findings suggest that telemedicine adoption is associated with reducing the use of certain low-value tests and modestly lower spending on visits and tests despite a slight increase in total visit rates. This indicates that telemedicine may offer potential benefits in reducing unnecessary healthcare utilization without contributing to excessive spending. However, the impact on other low-value tests remains limited, pointing to areas for further investigation.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2830180
References Ganguli, I., Lim, C., Daley, N., Cutler, D., Rosenthal, M., & Mehrotra, A. (2025). Telemedicine adoption and low-value care use and spending among fee-for-service medicare beneficiaries. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.8354
