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Telehealth proponents expected the pandemic to net them a windfall of convincing evidence that virtual care could increase quality and cut spending. But two years after health systems went virtual almost overnight, industry watchers are still disputing a key aspect that could determine telehealth’s fate: whether the option for virtual visits means patients will see doctors more often than they would in-person.

Whether telehealth is a substitute for — or an addition to — in-person care could clarify if it drives up costs for insurers and providers. Telehealth advocates have for years sought to prove to Congress that it’s a substitute, and that expanding Medicare coverage for virtual care wouldn’t significantly increase federal spending.

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