Episode Charges and Subsequent Visits After Telemedicine vs In-Person Care

Importance Telemedicine use increased during the COVID-19 pandemic and has remained a regular component of health care delivery. However, the financial implications of this change for health systems’ reimbursement and utilization remain unclear. Objective To compare 30-day episode charges and subsequent visits after telemedicine and in-person index visits. Design, Setting, and Participants The target trial emulation conducted in this comparative effectiveness research included ambulatory in-person and telemedicine visit data from an academic health system comprising 5 hospitals in Pennsylvania from January 1 to April 30, 2024. Analyses focused on 10 high-volume clinical conditions commonly managed through telemedicine. Exposures Telemedicine visits vs in-person visits. Main Outcomes and Measures Outcomes included episode charges (the billed amount submitted for reimbursement to insurers and patients, excluding physician professional and facility fees for the index encounter) in an episode window from 7 days before to 30 days after the index visit and the number of subsequent visits within the episode window. Linear regression and Poisson regression with propensity score matching were conducted to adjust for demographic, clinical, socioeconomic, and contextual factors. Results A total of 163 308 visits (108 383 66. 4% among females; mean SD patient age, 49. 2 19. 1 years) were included in this study. After propensity score matching, the mean 30-day episode charge was 96. 60 (95% CI, 92. 24-100. 96) for telemedicine encounters and 509. 21 (95% CI, 500. 65-517. 77) for in-person encounters (mean difference, 412. 62; 95% CI, 403. 01-422. 22). Additionally, telemedicine visits were associated with fewer follow-up visits per 30-day episode than were in-person visits (mean SD, 3. 44 5. 38 vs 4. 44 7. 41 visits; comparative reduction, 23% 95% CI, 20%-26%). For mental and behavioral disorders, 3 categories—depressive disorders (−69. 47; 95% CI, −100. 90 to −38. 04), anxiety and fear-related disorders (38. 06; 95% CI, 23. 14 to 52. 99), and neurodevelopmental disorders (−28. 88; 95% CI, −54. 72 to −3. 04) —exhibited comparable episode charges for telemedicine vs in-person encounters. Conclusions and Relevance In this comparative effectiveness research using target trial emulation of outpatient telemedicine and in-person visits, telemedicine visits overall were associated with lower charges and fewer subsequent visits within the 30-day episode than were in-person visits. For mental and behavioral conditions, charges were comparable. These findings suggest that telemedicine may serve as a lower-charge alternative to in-person care without increasing the need for subsequent visits.