Medicare’s Telehealth Experiment Could Be Here to Stay
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Medicare beneficiaries used 63 times more telehealth services in 2020 than in 2019 after the federal government loosened Medicare’s strict telehealth rules due to the COVID-19 pandemic, according to a report released Friday by the Department of Health and Human Services.
The policy changes were intended to be temporary, but data on telehealth use is being analyzed to help policymakers decide the future of those services under Medicare.
The HHS report "provides valuable insights into telehealth usage during the pandemic," said Chiquita Brooks-LaSure, who leads the Centers for Medicare & Medicaid Services, in a press release. "CMS will use these insights — along with input from people with Medicare and providers across the country — to inform further Medicare telehealth policies."
How did Medicare’s telehealth rules change in 2020?
Before 2020, Original Medicare covered telehealth only under fairly narrow circumstances (private insurers offering Medicare Advantage plans have much greater discretion to set their own telehealth policies).
Since the start of the COVID-19 pandemic, telehealth services under Medicare have been made more flexible in the following ways:
Only rural beneficiaries were eligible (except for a few special circumstances).
Urban and rural beneficiaries are eligible.
Services had to be provided at a health care facility.
Patients can receive telehealth services at home or at a health care facility.
A more limited set of services were eligible.
An additional 140 health care services are newly eligible.
A more limited set of providers and facilities were eligible.
Federally qualified health centers and rural health centers are newly eligible.
All telehealth services required audio and video interactions.
Some services are eligible for audio-only interactions, such as phone calls for behavioral health.
Medicare coinsurance and deductibles applied.
Providers have flexibility to reduce or waive cost-sharing requirements for telehealth visits.
What can 2020 Medicare telehealth data show?
Use of Medicare telehealth soared in 2020, but the extent of the change differed significantly in terms of provider types, geography and patient demographics. Telehealth applies primarily to care handled under Medicare Part B, which covers doctor visits and other outpatient medical services.
Telehealth soared while in-person visits fell sharply
In 2019, Part B beneficiaries had about 840,000 telehealth visits (about 1 visit for every 40 beneficiaries). In 2020, that number jumped to 52.7 million telehealth visits (about 1.6 visits for every beneficiary).
Trends were very different for health care overall. Original Medicare beneficiaries had 16.1% fewer in-person health care visits in 2020 compared with 2019.
All told, the vast majority of care under Part B — over 93% — was still delivered in person. As a result, the increase in telehealth doesn’t account for all of the pandemic-driven decline of in-person visits. Overall, there were about 11% fewer total visits of all types under Medicare Part B in 2020 compared with 2019.
Behavioral health had the largest shift to telehealth
About 38% of behavioral health visits in 2020 were telehealth visits — more than quadruple the rate of primary care (8.3%) and almost 15 times more than the rate for specialty care (2.6%).
The report notes two major factors that could contribute to the growth in telehealth for behavioral health services:
"Stress, loneliness, unemployment and economic uncertainty during the pandemic" could drive growth in mental health-related diagnoses and behavioral health services.
Behavioral health providers such as psychologists, psychiatrists and social workers were "well-suited to [provide] telehealth as physical exams or in-person diagnostic tests may be less frequently required."
Urban beneficiaries used more telehealth services
Before the pandemic, Medicare beneficiaries in rural areas could receive telehealth services, but others could use telehealth only if they had certain medical conditions. Many beneficiaries gained access to telehealth services through Medicare for the first time during the pandemic, and those outside of rural areas immediately began to use telehealth at higher rates than people in rural areas.
The report cites differences in broadband internet access, states’ preexisting telehealth policies and providers’ readiness to provide telehealth services as drivers of the rural-urban difference.
Significant racial differences in telehealth use
The report indicates that "all groups had a similar overall decrease in health care services in 2020," but Black beneficiaries, in particular, received the fewest telehealth services.
White beneficiaries used telehealth at rates equal to the overall average, and Hispanic and American Indian/Alaska Native beneficiaries used telehealth at higher rates. Asian American beneficiaries had the widest gap between urban and rural telehealth use: Rural Asian American beneficiaries used telehealth less than the average, while urban Asian American beneficiaries used telehealth at higher rates than any other group.
As with the urban-rural divide, the report notes that access to technology could be driving racial disparities. In particular, the report stresses "the need for policymakers to address the digital divide by increasing broadband access and supporting individuals’ access to and comfort with using internet-enabled technology and integrating telehealth with interpreter services."
What is the future of telehealth under Medicare?
The federal government expanded telehealth under Medicare as a temporary measure in response to the COVID-19 pandemic. The Centers for Medicare & Medicaid Services took administrative action to extend telehealth flexibility through 2023, but Congress would have to pass new legislation to make some of the changes permanent.
Because the overall effects of the COVID-19 pandemic on the health care system have been so pervasive, it’s difficult to draw telehealth-specific conclusions as a guide for making decisions.
Citing this difficulty, the HHS report concludes that its findings "underscore the need to carefully consider the extension of Medicare telehealth flexibilities after the pandemic ends and evaluate the impacts of telehealth on patient access, health care quality and health outcomes."
Similarly, the nonpartisan Medicare Payment Advisory Commission has recommended to Congress that many of the pandemic-era telehealth reforms should continue at least long enough to study their effects. A group of more than 400 health care-related organizations also signed a July 2021 letter urging Congress to make the Medicare telehealth reforms permanent.
A number of bipartisan bills currently in committee in Congress would extend various Medicare telehealth reforms, but it’s not clear whether any are likely to pass.
Take advantage of Medicare telehealth coverage
You can ask your health care providers for telehealth appointments in person, by phone or using a patient portal like MyChart. Depending on your health care needs, there could be several options to receive care without leaving your home:
Replace an in-person visit. A Medicare telehealth visit lets you communicate with health care providers in real time over the phone or video chat. Typically, you can have a Medicare telehealth visit only with a provider whom you have seen before in person. During the public health emergency, however, new patients are allowed to have telehealth visits even if they've never seen the provider before.
Check whether you need an appointment. A virtual check-in lets you briefly communicate with health care providers to decide whether an in-person visit is needed. You can either connect in real time over the phone or video chat, or you can send a message with any relevant audio or video attachments to your health care provider. Providers can respond by phone, audio or video recordings, secure text messages, email or messages in your patient portal. Virtual check-ins are available for established patients only.
Ask a quick question. An e-visit lets you send a secure message similar to an email to health care providers through your patient portal. If you have a quick, non-urgent question, it can be easier to send a message rather than waiting on the phone for a provider to be available. E-visits are available for established patients only.