Patients who visit providers via telemedicine undergo significantly fewer imaging exams

Patients who visit providers via telemedicine undergo significantly fewer imaging exams than those who do so in person, according to new research published Thursday. 

Amid the COVID-19 pandemic, recommendations for social distancing led to a marked uptick in such virtual visits. One analysis of claims for office-based physicians in the U.S. found that those offering telemedicine leapt from 15% in 2019 up to nearly 86% two years later. 

Researchers with the Neiman Health Policy Institute recently investigated how this shift impacted medical imaging services, sharing their findings in the Journal of the American College of Radiology. They found that diagnostic imaging was almost 30% less likely to occur, based on an analysis of over 23 million office visits conducted in 2021. 

“This study suggests that telemedicine, at least during the pandemic period studied, is not associated with increased imaging utilization,” study co-author Lauren P. Nicola, MD, CEO of Triad Radiology Associates, Winston Salem, North Carolina, said in a July 17 announcement from the policy institute. “As policymakers and health systems consider the future of virtual care, it’s important to recognize that telemedicine may offer a way to deliver care without contributing to overuse of imaging.” 

For their analysis, Nicola and colleagues utilized information from Optum’s de-identified claims database. They pinpointed patients who visited providers via telemedicine in 2021 and compared them with similar individuals who visited a clinician in person for the same reasons. Researchers then tracked imaging rates at the one-week mark, 14 days and one month later. Altogether, the analysis incorporated about 6.7 million patients who visited 570,000 clinicians that year, including primary care docs, surgeons, psychiatrists and nurse practitioners, among others. 

Out of over 23.4 million visits, about 10% (or 2.3 million) were conducted virtually. After matching, the post-visit imaging utilization rate was about 2.4 percentage points lower for telemedicine visits, representing a 29.7% relative difference. Patients who received imaging after a virtual visit had a slightly higher number of studies on average, the authors noted. But this effect was small, at just 0.02 additional studies on average when compared to in-person care. Findings were similar at the 14- and 30-day marks, the analysis determined. 

“These results indicate that greater use of telemedicine may not be a driver of increases in imaging volume,” the authors concluded, noting the analysis is potentially limited by selection bias. “Future studies should explore the appropriateness of imaging ordered during telemedicine visits and differences in adherence to orders in this setting versus in-person care.”