NINE HEALTH SYSTEMS SHOW TELEHEALTH REPLACES, NOT ADDS, MEDICARE VISITS

WASHINGTON, DC, NOVEMBER 24, 2025 – A new collaboration among nine major U.S. health systems from the American Telemedicine Association (ATA) Center of Digital Excellence (CODE) shows that virtual care is largely substitutive – replacing office visits rather than adding new ones. One of the first comprehensive looks at operational Medicare telehealth utilization patterns, this analysis examined real-world data across 1.67 million beneficiaries in 25 states and Washington, D.C. and found that Medicare patients averaged just 0.25 additional visits per year – essentially flat utilization despite massive virtual care growth.

“This data represents current state under a patchwork policy environment,” said Elissa Baker, BSN, RN, project lead of the analysis and founder of ATA CODE. “We’re just scratching the surface of what health systems could achieve with predictable legislative frameworks that let us build infrastructure to serve patients regardless of who’s paying the bills.”

Eight systems used collaborative methodology while one provided independent validation. The findings give federal analysts a unique window into how telehealth is embedded in everyday care and suggest that actual substitution patterns may differ from current budget modeling assumptions.

“What makes this analysis meaningful is that it reflects how telehealth is actually embedded in day-to-day care – real workflows and patient encounters, not theoretical models,” said Ethan Booker, MD, FACEP, Chief Medical Officer for Telehealth at MedStar Health and Chair of the ATA Clinician Council’s Clinical Frameworks & Evidence subcommittee. “Even with millions more virtual visits and the increased access to care, billed encounters per patient have stayed essentially flat.”

Across the participating healthcare systems serving 1.67 million Medicare beneficiaries, virtual visits grew 31-fold, but total Medicare use rose by only 0.25 visits per beneficiary, on average. In the largest Medicare population studied – more than 350,000 beneficiaries – virtual visits jumped more than 200-fold while total use increased by only 0.01 visits per patient.

Key Findings

Of the nine participating systems, six contributed Medicare Fee-for-Service data, one contributed Medicare ACO data, and one contributed all-payer data; a ninth provided independent validation through a rural case study. Related findings include:

• Virtual visits replace in-person care. Operational data suggests substitution patterns of 74% (95% CI: [68%, 80%]) across participating systems, substantially exceeding Congressional Budget Office’s (CBO) traditional assumptions of 30%.
• Big growth, little change overall. Even with significant increases in virtual visits, overall Medicare use remained essentially flat.
• Consistent across models and time periods. Academic medical centers, regional systems, integrated payer-providers, and rural hospitals all showed substitution during both pandemic and steady-state operations (2022-2023), suggesting durable patterns beyond emergency conditions.
• Rural validation. One system avoided 2,551 patient transfers / referrals to tertiary care providers (patients treated locally via telemedicine) and saved $8.1 million (from avoided referrals and any associated transport costs, showing how telehealth expands access without increasing overall use.
• Costs stay flat or fall. Where measured, systems saw costs remain stable or decrease with telehealth adoption.
• Workforce benefits. One system documented 42,000 nursing hours saved through virtual monitoring, relieving staffing shortages and improving clinician capacity.

This operational analysis provides directional evidence requiring validation through broader geographic representation and integration with claims-based research.

“Our qualitative experience told us that virtual care is a patient-satisfier and mostly a replacement for in-person care,” said Matt Anderson, MD, MHA, Advocate Health Senior Vice President and Chief Physician Executive, North Carolina & Georgia Division. “Now this analysis offers the quantitative data to back that up, showing how massive virtual care expansion translates to minimal overall utilization increases in practice.”

Read the full report here.

This analysis of telehealth utilization among Medicare beneficiaries was conducted by Baker, Anderson, and Guseyn-Zade, based on aggregated, system-level data provided by members of the ATA Center of Digital Excellence. All participating ATA CODE health system members retain ownership and control of the data they shared for this analysis.

“Our mission was to create structure, discipline, and trust across systems, and the outcome is real-world data that stands on its own. It’s a meaningful step forward for understanding the impact of digital care delivery,” added Samantha Guseyn-Zade, Project Administrator.

Participating systems included Advocate Health, Ballad Health, Intermountain Healthcare, Johns Hopkins Medicine, MedStar Health, OSF OnCall/OSF Healthcare, Sanford Health, UPMC, and WVU Medicine. Together they represent academic medical centers, integrated payer-provider systems, regional health systems, and rural providers. Additional validation came from Access TeleCare, a national acute care telemedicine organization serving hospitals in all 50 states, which reported similar substitution patterns with cost reductions in specialty care delivery.

About the ATA

As the only organization completely focused on advancing telehealth and digital health, the American Telemedicine Association is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people. The ATA represents a broad and inclusive member network of leading healthcare delivery systems, academic institutions, life sciences companies, technology solution providers and payers, as well as partner organizations and alliances, working to advance industry adoption of technology-enabled care, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

The ATA Center of Digital Excellence (CODE) is a health system–driven initiative of the American Telemedicine Association (ATA) focused on leveraging real-world insights and established approaches to inform best practices and benchmarking for digital care delivery. Its aim is to support the development of sustainable and effective models for integrating digital care.

For Federal Analyst Engagement:
Elissa Baker, BSN
ebaker@phase2health.com