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

INTRODUCTION: The COVID-19 pandemic necessitated rapid adaptations in healthcare delivery to ensure continuity of care while minimizing patient exposure to the virus. Telehealth emerged as a critical tool, supported by the Centers for Medicare and Medicaid Services (CMS) emergency waivers, which expanded telehealth services to include radiation treatment management. While telehealth has improved accessibility and convenience, its impact on clinical outcomes and healthcare utilization in oncology remains unclear. This study examines telehealth utilization during external beam radiation therapy episodes among Medicare beneficiaries, focusing on its association with emergency department (ED) visits, inpatient stays (IS), and related costs. METHODS: This retrospective cohort study analyzed Medicare beneficiaries who received external beam radiation therapy in outpatient hospital-based settings between 2020 and 2022. Radiation therapy episodes were constructed using the Medicare Standard Analytic Files (SAF) and included all treatment-related services provided over 90 days. Telehealth utilization was identified using Healthcare Common Procedure Coding System (HCPCS) codes, while ED visits and IS were determined from outpatient and inpatient claims. Multivariate logistic regression models were used to assess the association between telehealth use and healthcare utilization, adjusting for demographic and clinical risk factors. Costs were calculated based on Medicare payments and adjusted for inflation to account for changes in purchasing power over time. RESULTS: A total of 369,570 radiation therapy episodes were analyzed. Telehealth utilization declined from 9.6% in 2020 to 5.5% in 2022 but remained consistent within episodes where it was used. Patients utilizing telehealth had higher rates of ED visits (38.2% vs 30.2%) and IS (29.9% vs 21.6%) compared to those without telehealth. Multivariate analysis confirmed telehealth as a significant predictor of ED visits (p < 0.001, OR 1.057) and IS (p < 0.001, OR 1.080). Excess events attributed to telehealth use were estimated at 500 ED visits and 541 IS, with associated costs of $16.3 million during the study period. CONCLUSION: Telehealth has become an essential component of cancer care, especially during the COVID-19 pandemic. Telehealth use during radiation therapy episodes was associated with increased healthcare utilization and costs, highlighting the need for optimized telehealth delivery models. Proactive care coordination and symptom management strategies may mitigate these risks. Further research is needed to explore the long-term impact of telehealth on patient outcomes and to refine its role in oncology care.