Researchers find telemedicine may help reduce use of unnecessary health tests

(Press-News.org) Low-value care—medical tests and procedures that provide little to no benefit to patients—contributes to excess medical spending and both direct and cascading harms to patients. A research team from Mass General Brigham and their collaborators have found that telemedicine may help to reduce the use of low-value tests. The work is published in JAMA Internal Medicine. 

“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. 

Authorship: In addition to Ganguli, other Mass General Brigham authors include Nicholas E. Daley. 

Disclosures: Ganguli reported personal fees from F-Prime outside the submitted work. Dr Cutler reported grants from the Agency for Healthcare Research and Quality during the conduct of the study and personal fees from multidistrict litigation with respect to opioids and with respect to JUUL outside the submitted work. Dr Mehrotra reported personal fees from Black Opal Ventures outside the submitted work. No other disclosures were reported.  

Funding: This work was supported by grants from Arnold Ventures and the Commonwealth Fund. Ganguli’s work was also supported by the National Institute on Aging (K23AG068240). 

Paper cited: Ganguli I et al. “Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries” JAMA Internal Medicine DOI: 10.1001/jamainternmed.2024.8354 

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