Medicare telehealth boom hasn’t driven more visits, study finds

A new study of traditional Medicare patients finds that the rise of telehealth has not led to more office visits overall, even in the specialties that embraced virtual care the most. Instead, total visit volume stayed level or declined through mid-2024, according to researchers at the University of Michigan. The study is published in Health Affairs Scholar.

At the end of this month, Congress faces another deadline to decide whether to temporarily renew or permanently extend Medicare’s current telehealth coverage standards, which have been in place since March 2020.

If lawmakers miss that January 30 decision point, older and disabled Americans with traditional Medicare could again see confusion over which virtual visits are covered and which are not.

60 million patients, nearly 539 million visits

The team from the U-M Institute for Healthcare Policy and Innovation (IHPI) examined 100% of traditional Medicare fee-for-service (FFS) claims from Carrier and Outpatient files for beneficiaries 65 and older from January 2019 through June 2024.

The analysis included 60,531,036 patients and 538,801,822 outpatient office visits, focusing on evaluation and management services billed to Medicare.

To understand how telehealth adoption affected overall use of care, the researchers grouped specialists into three categories based on how likely they were to use telehealth.

1. Low telehealth use: Largely procedural and surgical fields, including otolaryngology, ophthalmology, orthopedic surgery, sports medicine, plastic and reconstructive surgery, hand surgery, podiatry and maxillofacial surgery.
2. Medium telehealth use: Primary care specialties (general practice, family practice, internal medicine, geriatrics, hospice and palliative care, preventive medicine, osteopathic manipulative therapy) plus medical and surgical subspecialties, including gastroenterology, pulmonology, nephrology, infectious disease, endocrinology, medical oncology, neurosurgery, thoracic surgery and surgical oncology.
3. High telehealth use: Behavioral health disciplines, including psychiatry, psychology, clinical psychology and neuropsychiatry.

Using a difference-in-differences model, the team compared total outpatient office visit volumes before the COVID-19 pandemic (January 2019–February 2020) and after telehealth flexibilities were in place (January 2021–June 2024), treating the low-telehealth specialties as a reference group.

In the post-pandemic period, telehealth accounted for 5.3% of outpatient office visits in the low-telehealth group, 9.1% in the medium-telehealth group and 43.8% in the high-telehealth behavioral group.

Total visit volume fell across all specialty groups

Despite that sustained use of virtual care, all three groups saw declines in the predicted number of total outpatient office visits per county-month when comparing the pre- and post-pandemic periods:

• Low telehealth group: From 12,588 to 10,831 visits — down 14%.
• Medium telehealth group: From 18,873 to 15,733 visits — down 17%.
• High telehealth group: From 3,264 to 2,682 visits — down 18%.

Compared with the low-telehealth specialties, both the medium and high groups had significantly larger declines in visit volume.

“One of the things that is paralyzing the policy debate is uncertainty and concern about whether covering telehealth in parity with in-person care would be associated with runaway utilization. But we don’t see that here,” said lead author James D. Lee, M.D., M.P.H., a National Clinician Scholar at IHPI.

The authors concluded that widespread post-pandemic telehealth adoption did “not appear to be associated with an increase in total outpatient office visit utilization among Medicare FFS beneficiaries.” Instead, they noted, telehealth visits “appear largely to have served as a substitute for in-person visits.”

Primary care and behavioral health

from Carrier and Outpatient files for beneficiaries 65 and older from January 2019 through June 2024.

At the same time, the total number of visits in non-surgical medical specialties and mental health stabilized or declined slightly through June 2024, even as virtual visits remained common. The release notes that the declining trend for primary care and behavioral health visits may reflect the shortage of clinicians in those fields, including reductions in capacity as burned-out clinicians cut back on appointment slots.

The study did not include asynchronous patient portal messages, which Medicare pays for under separate billing codes when clinicians spend enough time on those interactions. It also excluded services from clinicians who did not bill traditional FFS Medicare, including some mental health providers who are paid out of pocket.

Additionally, because the analysis relied on FFS claims, it did not capture utilization among beneficiaries enrolled in Medicare Advantage (MA) plans.

Another telehealth deadline looms

Before the COVID-19 pandemic, telehealth coverage in Medicare was limited. The public health emergency prompted a rapid expansion in March 2020, allowing many more types of visits to be delivered virtually. The current standards, extended several times through federal legislation, are now set to expire at the end of January unless Congress acts.

If lawmakers do not vote to either temporarily renew or permanently extend those standards by January 30, beneficiaries with traditional Medicare could again receive notices from practices that virtual visits will not be covered, or that scheduled appointments must be moved to in-person, canceled or rescheduled.

When the federal government shutdown began on October 1, 2025, there was a lapse in telehealth coverage for traditional Medicare. Some Medicare patients received letters warning that they might be responsible for the full cost of telehealth visits during that period, or that their virtual appointments were being converted or canceled. Congress later authorized retroactive payment for those visits, but only extended telehealth coverage under the current rules through the end of January 2026.

For now, the study gives policymakers another data point: in traditional Medicare, at least through June 2024, telehealth appears to have shifted where visits happen — on video or by phone vs. in-person — not how many visits happen overall.