{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:42Z","timestamp":1789995762010,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":52,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["U3GRH40003-01-03"],"award-info":[{"award-number":["U3GRH40003-01-03"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To address rural\u2212urban differences in health services use and costs among Medicare fee\u2010for\u2010service (FFS) beneficiaries by telehealth use before and during the COVID\u201019 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study population consisted of a nationally representative 5% sample of Medicare FFS beneficiaries aged 65 years and older during 2019\u22122020. Rural\u2212Urban Continuum Codes identified rural\u2212urban residential locations. Propensity scores were used to correct for selection bias and identify matching cohorts of telehealth and non\u2010telehealth users. Differences in health services use and costs by telehealth use were addressed using difference in differences logistic and generalized linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Telehealth use curbed the decline in in\u2010person outpatient visits for rural and urban beneficiaries early in the pandemic. During 2020, both rural and urban telehealth users had significantly lower probabilities of being hospitalized compared to 2019 (marginal effects [ME]: rural \u22120.22, urban \u22120.18), and were less likely to visit the emergency department (ED) (ME: rural \u22120.23, urban \u22120.20). Yet, telehealth users were more likely to be hospitalized than non\u2010telehealth users during 2020 (ME: rural 0.018, urban 0.011) and more likely to visit the ED (ME: rural 0.032, urban 0.024).<\/jats:p>\n                    <jats:p>While total costs were significantly higher for telehealth users (rural $8484, urban $7272) than non\u2010telehealth users (rural $6749, urban $5201) during 2020, total costs were reduced by a greater amount ($9200) for rural telehealth users than urban ($8000) and rural non\u2010telehealth ($6900) counterparts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While telehealth users realized higher total costs of care in 2019\u22122020, rural telehealth users realized greater declines in total costs than rural non\u2010telehealth users and urban beneficiaries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70152","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:55:51Z","timestamp":1776858951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Association Between Telehealth Use and Health Care Costs Among Rural Medicare Fee for Service Beneficiaries During the COVID\u201019 Pandemic"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-3445","authenticated-orcid":false,"given":"Yvonne","family":"Jonk","sequence":"first","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Thayer","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6936a4"},{"key":"e_1_2_8_3_1","unstructured":"Centers for Medicare & Medicaid Services Medicare and Medicaid Programs Basic Health Program and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID\u201019 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program(2020)."},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2021.01.009"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.S1.200247"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534735421999101"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2021.S1.200393"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.2618"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X18784103"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.17m11888"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11420\u2010020\u201009800\u20105"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15884"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05105"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.02.056"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20\u20103026"},{"key":"e_1_2_8_16_1","unstructured":"Department of Health and Human Services Billing Medicare as a Safety\u2010Net Provider. Department of Health and Human Services. Updated April 21 2021. Accessed January 31 2023.https:\/\/telehealth.hhs.gov\/providers\/billing\u2010and\u2010reimbursement\/billing\u2010medicare\u2010as\u2010a\u2010safety\u2010net\u2010provider\/."},{"key":"e_1_2_8_17_1","unstructured":"Centers for Medicare & Medicaid Services Medicare Telemedicine Health Care Provider Fact Sheet. U.S. Centers for Medicare & Medicaid Services. Updated March 17 2020. Accessed January 13 2023.https:\/\/www.cms.gov\/newsroom\/fact\u2010sheets\/medicare\u2010telemedicine\u2010health\u2010care\u2010provider\u2010fact\u2010sheet."},{"key":"e_1_2_8_18_1","unstructured":"Centers for Medicare & Medicaid Services List of Telehealth Services. U.S. Centers for Medicare & Medicaid Services. Updated November 2 2022. Accessed January 13 2023.https:\/\/www.cms.gov\/Medicare\/Medicare\u2010General\u2010Information\/Telehealth\/Telehealth\u2010Codes."},{"key":"e_1_2_8_19_1","volume-title":"The Johns Hopkins ACG System\u00ae: State of the Art Technology and a Tradition of Excellence in One Integrated Solution","author":"ACG JH","year":"2012"},{"key":"e_1_2_8_20_1","unstructured":"StataCorp LP [Computer Program]. Version SE 17.0(1985\u20132021)."},{"key":"e_1_2_8_21_1","unstructured":"SAS Institute [Computer Program]. 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Available at: Accessed November 9 2023.http:\/\/www.bls.gov\/cpi\/home.htm."},{"key":"e_1_2_8_28_1","unstructured":"L.Samson W.Tarazi G.Turrini andS.Sheingold Medicare Beneficiaries\u2019 Use of Telehealth Services in 2020 \u2013 Trends by Beneficiary Characteristics and Location (Issue Brief No. HP\u2010202127) (Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services 2021)."},{"key":"e_1_2_8_29_1","unstructured":"Centers for Medicare & Medicaid Services Medicare Telehealth Trends Report: January 1 2020 through September 30 2022. U.S. Centers for Medicare & Medicaid Services. 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