CureusExcess Cost of Telehealth Use in Radiation Oncology: A Medicare-Based Cohort Study

This retrospective Medicare cohort study (n=369,570 episodes, 2020-2022) examined telehealth utilization during external beam radiation therapy and its association with emergency department visits and inpatient stays. Using multivariate logistic regression controlling for demographic and clinical risk factors, researchers quantified excess healthcare utilization and costs attributed to virtual versus in-person weekly treatment management visits. The analysis revealed specialty-specific differences in telehealth effectiveness during concurrent chemoradiotherapy, suggesting care delivery model optimization opportunities.

⚕️ Key Clinical Considerations ⚕️

• Statistical significance with modest effect sizes: Telehealth predicted ED visits (OR 1.057, p<0.001) and inpatient stays (OR 1.080, p<0.001), translating to 500 excess ED visits and 541 excess hospitalizations across the cohort—clinically meaningful at population scale despite individual risk increases of 5.7% and 8.0% respectively.
• Specialty-dependent outcomes during chemoradiation: Among 59,716 concurrent chemoradiotherapy episodes, medical oncology telehealth significantly predicted excess ED visits and hospitalizations (p<0.001), while radiation oncology telehealth showed no significant association—suggesting specialty-specific workflows or patient acuity differences affect telehealth effectiveness.
• Persistent utilization patterns despite declining adoption: Telehealth use decreased from 9.6% (2020) to 5.5% (2022) of episodes, yet when employed, consistently replaced approximately 50% of weekly management visits throughout the study period, indicating sustained practice integration among adopting providers.
• Disease site-agnostic associations: Higher ED visit rates (38.2% vs 30.2%) and hospitalizations (29.9% vs 21.6%) with telehealth use occurred across cancer types except CNS and pancreatic malignancies, suggesting systemic care delivery factors rather than diagnosis-specific treatment complexity drive utilization differences.
• Methodological limitations in causality determination: Claims-based retrospective design cannot establish whether telehealth directly caused increased utilization or served as a marker for higher-risk patients, unmeasured confounders (symptom severity, patient preference, provider selection bias), or inadequate remote assessment capabilities—prospective trials needed.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Discuss telehealth trade-offs transparently—convenience benefits versus potential gaps in physical assessment that may delay intervention for treatment toxicities. Set expectations for hybrid models combining strategic in-person visits at high-risk timepoints with remote monitoring.
• Practice Integration: Consider risk-stratified telehealth protocols: reserve virtual visits for low-toxicity regimens (breast, prostate) while maintaining in-person assessment for high-complexity treatments (head/neck, concurrent chemoradiation). Implement standardized symptom screening tools and escalation pathways for remote encounters.
• Proactive Symptom Management: Deploy telehealth-augmented care coordination—triage nurses, symptom navigators, or fast-track clinic access—to bridge assessment gaps. Monitor institutional ED/hospitalization rates stratified by visit modality to identify process improvement opportunities.
• Risk Management: Document telehealth visit limitations in real-time (inability to assess mucositis severity, skin reaction progression) and establish clear pathways for urgent in-person evaluation. Consider liability implications of remote assessment inadequacy when treatment complications escalate.

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