Telehealth and Outpatient Utilization: Trends in Evaluation and Management Visits Among Medicare Fee-For-Service Beneficiaries, 2019-2024

IntroductionTelehealth expanded rapidly following the COVID-19 pandemic and has become an integral part of healthcare delivery. However, concerns remain that increased telehealth availability may contribute to higher overall healthcare utilization and spending. To assess telehealths impact on outpatient evaluation and management (E&M) visit volume, we compared overall E&M utilization before and after the pandemic across specialties with varying levels of telehealth use. MethodsWe analyzed 100% Medicare Fee-For-Service (FFS) claims to compare monthly outpatient E&M visit rates between two periods: pre-pandemic (January 2019-February 2020) and post-pandemic (January 2021-June 2024). Specialties were categorized by telehealth use as high (behavioral health), medium (primary care), and low (orthopedic surgery). A difference-in-differences (DID) analysis was used to assess changes in visit volume associated with telehealth. ResultsPrior to the pandemic, telehealth accounted for just 0.1% of monthly E&M visits but surged to 41.0% in April 2020 before stabilizing between 5.7% and 7.0% in 2023-2024. The average monthly E&M visit rate per 1,000 FFS beneficiaries was 906.8 pre-pandemic and 918.6 post-pandemic. In the post-pandemic period, telehealth comprised 1.2% of E&M visits in low-use specialties, 8.4% in medium-use specialties, and 43.8% in high-use specialties. Compared to the expected trend based on the low telehealth-use specialty, high and medium telehealth-use specialties experienced a 4.1% and 7.2% relative decline in overall E&M visits, respectively, in the post-pandemic period. ConclusionFollowing an initial surge, telehealth use stabilized in 2021 and beyond. Overall outpatient utilization remained stable post-pandemic, and increased telehealth adoption was not associated with a rise in total outpatient E&M visits. These findings suggest that broad telehealth adoption has not led to increased healthcare utilization among Medicare FFS beneficiaries.