{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:05:11Z","timestamp":1792886711883,"version":"4.5.0"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec id=\"ab-ioi240099-4\"><jats:title>Importance<\/jats:title><jats:p>Low-value care is a persistent problem with direct and cascading harms. Telemedicine is now commonly used and may reduce low-value testing by introducing barriers to completing tests at a given visit or expand opportunities for low-value testing by contributing to higher visit volumes.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-5\"><jats:title>Objective<\/jats:title><jats:p>To quantify the association between telemedicine adoption and low-value testing among fee-for-service Medicare beneficiaries.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In this cohort study using 100% fee-for-service Medicare claims data, US health systems were divided into quartiles based on 2020 telemedicine adoption. Beneficiary-level linear regression in difference-in-differences (DiD) analyses was used to compare beneficiaries who were continuously enrolled from 2019 through 2022 and were attributed before telemedicine adoption (2019) to high telemedicine\u2013adopting (top quartile) vs low telemedicine\u2013adopting (bottom quartile) health systems on low-value test and visit outcomes in 2022 vs 2019. Data were analyzed from October 2023 to December 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-7\"><jats:title>Exposure<\/jats:title><jats:p>Health system telemedicine adoption.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Receipt of, and spending on, 20 low-value screening, preoperative, chronic condition management, and acute diagnostic tests, as well as total visits (in person and virtual).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-9\"><jats:title>Results<\/jats:title><jats:p>The sample included 1\u202f382\u202f033 beneficiaries who were attributed to high-telemedicine systems (mean [SD] age, 71.6 [10.5] years; 58.8% female) and 999\u202f051 beneficiaries who were attributed to low-telemedicine systems (mean [SD] age, 71.8 [10.0] years; 57.0% female). From 2019 to 2022, those in high-telemedicine systems had a small differential rise in visits (DiD visits per beneficiary, 0.12; 95% CI, 0.03 to 0.21) and differential decreases in use of 7 of 20 low-value tests: cervical cancer screening (DiD, \u22120.45 percentage points [pp]; 95% CI, \u22120.72 to \u22120.17 pp), screening electrocardiograms (DiD, \u22121.30 pp; 95% CI, \u22121.96 to \u22120.65 pp), screening metabolic panels (DiD, \u22121.84 pp; 95% CI, \u22122.87 to \u22120.80 pp), preoperative complete blood cell counts (DiD, \u22120.64 pp; 95% CI, \u22121.06 to \u22120.22 pp), preoperative metabolic panels (DiD, \u22121.35 pp; \u22121.91 to \u22120.80 pp), total or free T3 (triiodothyronine) level testing for hypothyroidism (DiD, \u22120.90 pp; 95% CI, \u22121.38 to \u22120.41 pp), and imaging for uncomplicated low back pain (DiD, \u22121.66 pp; 95% CI, \u22122.35 to \u22120.98 pp). There were no statistically significant differences in other tests. Those in high-telemedicine systems saw statistically significant differential decreases in spending on visits per beneficiary (\u2212$47.87; 95% CI, \u2212$86.85 to \u2212$8.88) and on 2 of 20 low-value tests, but no differences in low-value spending overall.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240099-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cohort study, telemedicine adoption was associated with modestly lower use of 7 of 20 examined low-value tests (most point-of-care) and no changes in use of other low-value tests, despite a small rise in total visits that might offer more testing opportunities. Results suggest possible benefits of telemedicine and mitigate concerns about telemedicine contributing to increased spending.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.8354","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T16:35:29Z","timestamp":1740414929000},"page":"440","source":"Crossref","is-referenced-by-count":16,"title":["Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries"],"prefix":"10.1001","volume":"185","author":[{"given":"Ishani","family":"Ganguli","sequence":"first","affiliation":[{"name":"Harvard University, Boston, Massachusetts"},{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Associate Editor, JAMA Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Lim","sequence":"additional","affiliation":[{"name":"Harvard University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Daley","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Primary Care, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cutler","sequence":"additional","affiliation":[{"name":"Harvard University, Boston, Massachusetts"},{"name":"National Bureau of Economic Research, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Harvard University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ateev","family":"Mehrotra","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health, Providence, Rhode 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Centers for Medicare & Medicaid Services. July 10, 2024. Accessed August 8, 2024. https:\/\/www.cms.gov\/newsroom\/fact-sheets\/calendar-year-cy-2025-medicare-physician-fee-schedule-proposed-rule"},{"key":"ioi240099r37","unstructured":"Restructured BETOS Classification System. Centers for Medicare & Medicaid Services. Accessed September 20, 2023. https:\/\/data.cms.gov\/provider-summary-by-type-of-service\/provider-service-classifications\/restructured-betos-classification-system"},{"key":"ioi240099r39","unstructured":"US Preventive Services Task Force website. Accessed October 21, 2024. https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/"},{"key":"ioi240099r45","unstructured":"Gross domestic product: implicit price deflator. Federal Reserve Bank of St. Louis. July 25, 2024. Accessed August 14, 2024. https:\/\/fred.stlouisfed.org\/series\/GDPDEF"},{"key":"ioi240099r47","unstructured":"Condition categories. Chronic Conditions Data Warehouse. 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