As the United States approaches another critical decision point on Medicare telehealth reimbursement, new research from the University of Michigan provides timely, evidence-based input to an increasingly polarised policy debate. The study shows that the large-scale adoption of telehealth since the COVID-19 pandemic has not resulted in higher overall healthcare utilisation, countering concerns that virtual care would drive excessive demand and costs.
The analysis, published in Health Affairs Scholar, is based on longitudinal data from more than 60 million individuals covered by traditional fee-for-service Medicare. In total, nearly 539 million outpatient visits were analysed over a five-year period, from January 2019 through June 2024. The researchers examined trends across surgical specialties, non-surgical medical care and behavioural (mental) health services, comparing in-person and virtual visits.
Patient visits remeined stable
The findings are clear: while telehealth has become a routine mode of care delivery, the total number of patient visits has remained stable or declined slightly. This trend was particularly visible in non-surgical medical specialties and behavioural health, even in areas where telehealth adoption was high. In other words, virtual care appears to be substituting for in-person visits rather than adding new ones.
Telehealth utilisation has grown substantially since emergency coverage rules were introduced in March 2020. According to the study, telehealth now accounts for around 44% of behavioural health visits and 9% of primary care visits among Medicare beneficiaries. Despite this sustained uptake, there was no evidence of a corresponding increase in total visit volumes.
January deadline
The timing of the research is significant. US policymakers face a January deadline to decide whether to extend or permanently adopt current Medicare telehealth reimbursement standards. If no agreement is reached, millions of older and disabled Americans could again face uncertainty about coverage, similar to the situation during the government shutdown in October 2023, when some patients were warned they might have to pay out of pocket for virtual visits or see their appointments cancelled or converted to in-person care.
Lead author James D. Lee, a clinician and health services researcher, emphasises the importance of looking at the full picture. According to Lee, much of the policy debate has been driven by fears that paying for telehealth on equal terms with in-person care would lead to runaway utilisation. “Our findings do not support that assumption,” he notes. “Even in specialties where telehealth use is widespread, overall visit numbers have not increased.”
Senior author Chad Ellimoottil adds that the slight decline in total visits observed in primary care and behavioural health may reflect broader system pressures, including longstanding workforce shortages and reduced appointment capacity due to provider burnout.
Several limitations
The researchers note several limitations. The analysis does not include asynchronous digital interactions, such as patient portal messages, nor does it capture care paid for out of pocket or delivered under Medicare Advantage plans, which cover roughly half of all Medicare beneficiaries. Nevertheless, the scale and duration of the dataset make the findings highly relevant for national policy discussions.
Overall, the study suggests that telehealth can enhance access and flexibility without increasing overall healthcare demand. For policymakers seeking to balance patient access, system sustainability and budgetary responsibility, the message is clear: telehealth expansion does not appear to fuel overuse, and may be an essential tool in a healthcare system under strain.
