- As large numbers of providers and patients turned to telemedicine during COVID-19, the highest increase in the use of virtual care occurred among people in the most disadvantaged neighborhoods, according to a new study in Health Affairs that tracked Medicare beneficiaries.
- The findings are surprising, the researchers from Johns Hopkins University and Brigham and Women's Hospital in Boston said, because they contrast with earlier studies suggesting an inverse link between socioeconomic status and use of telemedicine in the pandemic, and a worsening of pre-existing racial disparities in certain populations.
- The new research found telemedicine access and use increased for all minority groups during the pandemic, compared with White patients. One notable exception in the overall trend toward greater use of telemedicine across nearly all populations was older adults, whose use of virtual care showed declines with age both before and during the pandemic.
Telemedicine skyrocketed after CMS relaxed restrictions on geographic location and allowed providers to bill for virtual patient visits at the same rate as in-person visits during the public health emergency. The Medicare telemedicine coverage waiver issued early 2020 also reduced or eliminated standard coinsurance and deductible costs for virtual services.
A report from the nonprofit Fair Health that analyzed a database of 36 billion private insurance claims calculated that telehealth use surged in the U.S. in the first year of the pandemic. More recently, telehealth usage rebounded in the winter months following dips last summer and fall, with demand for virtual services appearing to fluctuate along with COVID-19 case numbers.
The Johns Hopkins study analyzed about 30 million Medicare fee-for-service claims to quantify outpatient telemedicine visits before and after the coverage waiver took effect.
Patient characteristics were evaluated using the Area Deprivation Index, a measure of neighborhood socioeconomic disadvantage incorporating household income, education, employment and housing quality. Patient-level ADI rankings were obtained from the University of Wisconsin's Neighborhood Atlas.
Before the Medicare waiver, telemedicine was covered only for patients in designated rural areas or certain medical facilities.
Fewer than 1% of all patients had at least one virtual visit, and there were no significant differences between people living in the most versus least disadvantaged neighborhoods.
After the waiver, nearly 10% of patients overall had at least one telemedicine visit, with the highest use found among people in the most disadvantaged locations. The data suggests a substantial increase in accessibility for patients in metropolitan areas who were previously ineligible for telemedicine coverage under Medicare, the researchers said.
People aged 85 and older had the lowest rates of telemedicine use in both the pre- and post-waiver periods. Older adults are less likely to own devices such as smartphones, creating a major barrier to telehealth care in the elderly, the researchers said.
With other studies linking telemedicine to improved health outcomes relative to regular care, the data support the need for legislation that would allow continued reimbursement for telehealth services beyond the public health emergency and targeted efforts to improve access for all populations, they said.