JMIR Publications

ABSTRACT

Background:

Now is an especially important time to decide whether telehealth (virtual visits) should be continued at current levels or reduced in favor of in-person visits. While the quantity of telehealth visits had increased due to the pandemic, this trend is now shifting downward. Thus, health care leaders and policy makers need to understand the impact of discontinuing telehealth virtual visits as they try to make essential decisions.

Objective:

To help U.S. hospital health care leaders and policy makers understand the potential tradeoffs associated with discontinuing telehealth virtual visits.

Methods:

We analyze impacts of telehealth discontinuation by a minority of U.S. hospitals on emergency department visits, total ambulatory visits (minus ED visits), outpatient services revenue, and total facility expenses for the pre-pandemic 2016-2018 time period. We apply a difference-in-differences (DID) research design to this quasi-natural experiment and propensity score matching for balancing covariates between treatment and control groups. Our primary data is from the American Hospital Association (AHA) Annual Survey and the Health Care Cost Reports Information System (HCRIS) data for 2016-2018. Control variables were obtained from additional sources, including the Federal Communications Commission (FCC) for maximum broadband speeds per U.S. county. Our primary variable of interest is whether a given U.S. hospital had telehealth in 2016 (or 2017) and then subsequently discontinued use of telehealth in 2017 (or 2018) (n = 92 U.S. hospitals in the treatment group). U.S. hospitals during this time period that had and then discontinued telehealth were included in the sample. Additional hospitals that offered telehealth for all three years were included as controls, as selected via propensity score matching (n = 92 clusters in the control group, representing 432 U.S. hospitals).

Results:

We find that telehealth discontinuation by U.S. hospitals during the 2016-2018 time period significantly reduced hospital outpatient services revenue (P = 0.02) but, interestingly, did not have a significant impact on total facility expenses (P = 0.68) or total ambulatory visits (P = 0.24). A marginal negative impact (P = 0.08) was found on ED visits.

Conclusions:

The findings provide information for leaders and policy makers making telehealth decisions. Our findings suggest that hospitals with thin profit margins should likely continue telehealth programs. The marginal negative impact on ED visits and non-significant impacts on total ambulatory visits and total facility expenses raise opportunities for future research. Clinical Trial: None