- The number of Medicare beneficiaries using telehealth skyrocketed in the early weeks of the pandemic as the Trump administration relaxed regulations to virtual care.
- Almost 1.3 million members received telehealth services in the week ending April 18, compared to just 11,000 in the week ending March 7, according to current Medicare claims data — an increase of more than 11,718% in just a month and a half.
- The looser regulations are only in place for the extent of the national public health emergency, but myriad groups have called on HHS to permanently relax the barriers. Top administration health officials have said they're exploring the possibility.
Federal agencies, public payers and large commercial insurers alike have scrambled to expand access to telehealth amid the pandemic, slashing cost-sharing, removing regulatory and administrative roadblocks and distributing funding to build out communities' health IT infrastructure.
Seniors are at particular risk for severe illness and complications from the novel coronavirus, which has killed 100,000 people in the U.S. as of Wednesday. There have been early signs that seniors are adopting telehealth at unprecedented rates amid the pandemic, as receiving healthcare digitally shelters them from potentially coming into contact with an infected person at a doctor's office.
However, this claims data are some of the first concrete figures reflecting just how quickly fee-for-service Medicare beneficiaries warmed to the concept of virtual care.
"It's not that this was necessarily unexpected, but this is really five to 10 years of progress taking place in a month and a half," Tim Epple, a principal at health consultancy Avalere, told Healthcare Dive. "Actually seeing it happen is an entirely different story."
Previously, telehealth use in Medicare was severely restricted to specific locations and circumstances, like for beneficiaries in rural areas or patients already in a hospital. According to CMS, only 90,000 fee-for-service Medicare beneficiaries used virtual care through the entire 2016 calendar year — seven times fewer than the amount that used telehealth the week ending April 4 alone.
The Trump administration began easing barriers to virtual care in early March, allowing Medicare to temporarily reimburse telehealth appointments at the same rate as in-office visits, and saying it would not enforce HIPAA privacy law penalties curtailing telehealth use. CMS has sharply expanded the number of services available via virtual care, upped payments for audio-only visits and granted a blanket waiver enabling providers licensed in one state to provide services to patients in another.
CMS Administrator Seema Verma told reporters on a call Tuesday her department is evaluating the telehealth waivers to determine if they should be extended past the scope of the national emergency, and is in the process of additional rulemaking around the issue.
"You'll see that some of the provisions that we have extended on a temporary basis will be made permanent," Verma said.
Health IT and provider groups, along with some politicians, have called on CMS to keep most if not all of the changes.
Informatics executive group CHIME wrote the agency on Friday urging continued payment for telehealth services at higher rates, including for audio-only visits, to maintain patient access to medical care and help providers transition as some regions of the U.S. see their curve start to plateau.
Ongoing access to virtual care will "smooth the glide path as the American medical system transitions from COVID-19 trauma care back to standard operations," CHIME said.
There are some indications telehealth use is flattening somewhat following an early explosion in demand as states begin to slowly reopen businesses, and doctors resume more in-person operations. Outpatient visits have begun to rebound nationwide, according to a report from The Commonwealth Fund, and there are some procedures and treatments doctors just can't do digitally.
But analysts say virtual care is likely to remain popular for low-acuity care, like chronic disease management, behavioral healthcare and evaluation visits that can easily be conducted through a telehealth modality, especially if CMS retains telehealth payment parity for Medicare's 44 million beneficiaries.
"There's a huge impetus for those types of services to expand if those recent flexibilities stick," Chad Brooker, an associate principal at Avalere, told Healthcare Dive. "I think that's the biggest question — what remains."