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Health Aff (Millwood). 2018 Dec;37(12):2045-2051. doi: 10.1377/hlthaff.2018.05105.

Virtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice.

Author information

1
Sachin J. Shah ( sachin.shah@ucsf.edu ) is an assistant professor of medicine at the University of California San Francisco.
2
Lee H. Schwamm is executive vice chair of neurology and director of the Center for TeleHealth at Massachusetts General Hospital, and a professor of neurology at Harvard Medical School, both in Boston.
3
Adam B. Cohen is health technologies program manager at the Johns Hopkins University Applied Physics Laboratory, in Laurel, and an assistant professor of neurology in the Johns Hopkins Hospital and Health System, in Baltimore, both in Maryland.
4
Marcy R. Simoni is director of the Virtual Visit Program at the Center for TeleHealth, Massachusetts General Hospital.
5
Juan Estrada is senior director of the Virtual Consult Program at the Center for TeleHealth, Massachusetts General Hospital.
6
Marcelo Matiello is director of Neurology Inpatient Services and Routine and Urgent Teleneurology Program at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School, in Boston.
7
Atheendar Venkataramani is an assistant professor of medical ethics and of health policy at the University of Pennsylvania Perelman School of Medicine, in Philadelphia.
8
Sandhya K. Rao is senior medical director for population health management at Partners Healthcare and an assistant professor of medicine at Harvard Medical School, both in Boston.

Abstract

Specialty care contributes significantly to total medical expenditures, for which accountable care organizations (ACOs) are responsible. ACOs have sought to replace costly in-person visits with lower-cost alternatives such as virtual visits (videoconferencing with physicians). In fee-for-service environments, virtual visits appear to add to in-person visits instead of replacing them. While this may be less of a problem within ACOs, whether virtual visits reduce in-person visits in an ACO is not known. Using data from over 35,000 patients in the period 2014-17 within a Massachusetts-based ACO, we found that the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years. While the use of virtual visits reduced in-person visits soon after registering with the program, the effect did not endure beyond a year. Whether and how virtual visits can substitute for in-person care in the long term are open questions.

PMID:
30633681
DOI:
10.1377/hlthaff.2018.05105

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