- Just over one in four Medicare beneficiaries used a telehealth visit between the summer and fall last year — a substantial increase in use as the COVID-19 pandemic caused patients, even tech-leery seniors, to seek out medical care in the safety of their homes, according to a new analysis.
- More than half of beneficiaries who had a visit used only a telephone, the Kaiser Family Foundation report said.
- Washington is currently deliberating over what COVID-19-era flexibilities should remain after the public health crisis ends, including permanent access for audio-only services. Prior to the pandemic, Medicare beneficiaries could only use telehealth in rural areas, with heavy restrictions on which beneficiaries could use the services and what providers could be paid for them.
Telehealth use exploded last year as the pandemic drove historic consumer demand for digitally delivered care. That demand continued in 2021, though there are some early signs utilization is waning as the vaccination effort continues in the U.S.
The new KFF analysis of CMS survey data of Medicare patients living in the community adds to other reports showing a sharp increase in Medicare beneficiaries' telehealth use in 2020. Researchers found 64% of beneficiaries said their provider currently offers telehealth appointments, up from just 18% pre-pandemic.
However, 23% of beneficiaries don't know whether their physician offers virtual care. That hikes to 30% among rural beneficiaries, who are more likely to live farther away from a provider and could benefit from access to virtual visits.
Among the almost 34 million beneficiaries whose providers offer telehealth, 45% said they had a virtual visit between the summer and fall of 2020. That translates to just over one in four (27%, or 15 million) of all beneficiaries in Medicare, KFF found.
Congress is currently debating how much telehealth access should be allowed as the pandemic wanes. The Trump administration in March last year temporarily nixed restrictions to virtual care use for the duration of the public health emergency, which the Biden administration most recently renewed in April and said is likely to remain for all of 2021.
A number of bills have been introduced in Congress that would codify broader telehealth access, including the Protecting Access to Post-COVID–19 Telehealth Act of 2021, which would permanently cover some of the recent expansions; the Telehealth Expansion Act of 2020, which would expand the mental health and evaluation and management services available via telehealth; and a bill expanding what providers can be paid for telehealth under Medicare.
As a result of broad support on the Hill, U.S. patients will almost certainly emerge from the pandemic with greater access to digitally delivered care. In a series of recent House and Senate committee hearings on the topic, legislators expressed support for nixing originating site and geographic requirements to coverage that made it difficult to use telemedicine widely, and allowing traditional Medicare to reimburse broadly for the service.
However, lawmakers seem torn on keeping payment parity for digitally delivered services, where federal payers reimburse for telehealth visits the same as in-person visits for the same service, and permanently removing HIPAA restrictions allowing providers to conduct visits over a broad array of platforms like Skype and Facetime.
Another thorny question is whether audio-only telehealth services delivered over the telephone will continue, as some worry allowing providers to bill for a simply phone call could lead to overutilization, fraud and abuse, injecting more cost into the system.
But the KFF report found Medicare beneficiaries used audio-only services at high rates, with a majority (56%) of beneficiaries utilizing telehealth accessed it only using a telephone. That's compared to 28% who used video and 16% that utilized both.
The share of beneficiaries utilizing audio-only visits was higher among those aged 75 and older, Hispanic beneficiaries, people in rural areas and dual-eligible patients.
"An expanded telehealth benefit that requires two-way video communication could be a barrier to care for subgroups of the Medicare population that relied more heavily on telephones than video-capable devices during the pandemic," KFF researchers wrote.
The report also found certain types of beneficiaries were more likely to use telehealth than others; including beneficiaries under the age of 65 with long-term disabilities; Black and Hispanic patients; dual-eligible beneficiaries; and those with chronic conditions.
There was no difference in utilization between beneficiaries in traditional, fee-for-service Medicare and those in privately run Medicare Advantage plans.