Variation in Telehealth Reimbursement After Hospital Discharge: Evidence Across Payers, Providers, and Market...

Timely follow-up after discharge can prevent hospital readmission, making telehealth (TH) a valuable modality for ensuring access and continuity of care. We quantify variation in TH reimbursement after hospital discharge across payers, providers, and market characteristics, and examine whether gaps in TH reimbursement narrowed or persisted in the post-COVID era.

Using a large postdischarge cohort (N = 276 922 TH visits; 167 922 unique patients), we estimated allowed payments for TH encounters via generalized linear models. Furthermore, to assess dynamics over time, we applied autoregressive integrated moving average models.

Commercial payers reimbursed consistently more than Medicare (avg $130.85 vs $83.62), surgeons more than physicians and nonphysicians ($138.64 vs $126.12 vs $108.61), and metropolitan areas more than nonmetro areas ($128.07 vs $85.77). Reimbursement was highest in least socially vulnerable areas ($123.29 vs $110.92 in highly vulnerable areas) and for audio-video visits ($132.10 vs $65.67 for audio-only visits). Heterogeneity analyses showed payer-provider and payer-modality gaps persisted across various subgroups. Time-series models revealed largely parallel or divergent trajectories after the pandemic, indicating persistent rather than converging disparities; robustness checks confirmed Medicaid payments were uniformly subject to lowest reimbursement.

Intra-TH reimbursement gaps observed in this study appear consistent with structural fee schedules and contracting arrangements, rather than temporary fluctuations. Without targeted adjustments, such as geographic add-ons, modality floor rates, or specialty-neutral pricing, TH expansion could risk contributing to inequities in postdischarge care. Although our analysis is descriptive, the patterns observed here suggest that structural factors, rather than short-term shocks, may underlie these reimbursement differences.