When there was greater use of telehealth during pandemic, there were more clinician encounters: study

High telehealth use among Medicare beneficiaries during the pandemic was linked to more clinician encounters and ambulatory care–sensitive hospitalizations, according to a study published Monday in JAMA Network Open.

Increased telehealth use wasn’t linked to additional emergency department visits, the data showed.

Data compared 3,436 hospital service areas that included about 30 million people using Medicare with different levels of telehealth use. During the height of the pandemic, Medicare expanded telehealth use for beneficiaries.

The average age of participants in 2019 was 71.04 years old. The study began during the end of 2019 (before the COVID-19 pandemic began), and went through the latter part of 2021, which was when telehealth was more widely used. Telehealth use peaked in the second quarter of 2020, when 47% of Medicare users used it, and it fell to about 15% at the end of 2022, the authors pointed out.

During the time frame studied, ACS hospitalizations and emergency visits declined, as did mean clinician encounters, though there was an average total cost of care that went up slightly. The rate of hospitalizations was higher among those using telehealth more compared to hospitalizations when telehealth was less utilized. Higher telehealth was linked to 1.63 additional hospitalizations per 1,000 beneficiaries; 0.30 additional clinician encounters and a $164.99 higher total cost of care.

The largest increases for the high telehealth intensity hospital service areas HSAs come from hospitalist encounters, which increased by 7.11% of the baseline rate. Encounters with advanced practice registered nurses (APRNs) went up 6.6% and physician assistant (PA) encounters went up by 4%; encounters with other practitioners (including psychologists and social workers) all went up as well, the data showed.

“COVID-19 cases were still high during the period of study, which suggests that these findings partially reflect a higher capacity for providing health services in HSAs with higher telehealth intensity than other HSAs,” the authors wrote.