Medicare's Telehealth Experiment Might Stick Around

Although the policy changes were intended to be temporary, data on telehealth use is being analyzed to assist policymakers in determining the future of those services under Medicare.

According to Chiquita Brooks-LaSure, director of the Centers for Medicare & Medicaid Services, the HHS report "provides valuable insights into telehealth usage during the pandemic." "CMS will use these insights, as well as input from Medicare beneficiaries and providers across the country, to inform future Medicare telehealth policies."

In 2020, How Did Medicare's Telehealth Rules Change?

Prior to 2020, Original Medicare only covered telehealth in very limited circumstances (private insurers offering Medicare Advantage plans have much greater discretion to set their own telehealth policies).

Since the beginning of the COVID-19 pandemic, Medicare telehealth services have become more flexible in the following ways:

What Will The 2020 Medicare Telehealth Data Reveal?

The use of Medicare telehealth increased dramatically in 2020, but the magnitude of the increase varied greatly depending on provider type, geography, and patient demographics. Telehealth is most commonly associated with care provided under Medicare Part B, which covers doctor visits and other outpatient medical services.

Telehealth is on the rise, while in-person visits are on the decline.

In 2019, approximately 840,000 telehealth visits were made by Part B beneficiaries (about 1 visit for every 40 beneficiaries). By 2020, that figure will have risen to 52.7 million telehealth visits (about 1.6 visits for every beneficiary).

The overall trends in health care were very different. In 2020, original Medicare beneficiaries had 16.1% fewer in-person health care visits than in 2019.

Overall, the vast majority of Part B care — more than 93% — was still delivered in person. As a result, the increase in telehealth does not account for the entire decline in in-person visits caused by the pandemic. In 2020, there were approximately 11% fewer total visits of all types under Medicare Part B than in 2019.

The most significant shift to telehealth was in behavioural health.

In 2020, telehealth visits will account for approximately 38% of behavioral health visits, more than quadrupling the rate of primary care (8.3%) and nearly 15 times the rate of specialty care (2.6%).

The report identifies two major factors that could contribute to the growth of behavioral health telehealth:

•During the pandemic, "stress, loneliness, unemployment, and economic uncertainty" may drive an increase in mental health diagnoses and behavioral health services.

•Psychologists, psychiatrists, and social workers were "well-suited to [provide] telehealth because physical exams or in-person diagnostic tests may be less frequently required."

Telehealth services were used more frequently by urban beneficiaries.

Prior to the pandemic, Medicare beneficiaries in rural areas could access telehealth services, but others could only do so if they had certain medical conditions. During the pandemic, many beneficiaries gained access to telehealth services for the first time through Medicare, and those living outside of rural areas began to use telehealth at a higher rate than those living in rural areas.

The report attributes the rural-urban divide to differences in broadband internet access, pre-existing telehealth policies in states, and providers' readiness to provide telehealth services.

Significant racial disparities in telehealth utilisation

According to the report, "all groups experienced a similar overall decrease in health care services in 2020," but Black beneficiaries received the fewest telehealth services.

White beneficiaries used telehealth at the same rate as the overall average, while Hispanic and American Indian/Alaska Native beneficiaries used it more frequently. Asian American beneficiaries had the greatest disparity in telehealth use between urban and rural areas: rural Asian American beneficiaries used telehealth less than the average, while urban Asian American beneficiaries used telehealth more than any other group.

As with the urban-rural divide, the report suggests that racial disparities may be driven by access to technology. The report specifically emphasizes "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, as well as integrating telehealth with interpreter services."

What Does The Future Of Telehealth Look Like Under Medicare?

In response to the COVID-19 pandemic, the federal government expanded telehealth under Medicare as a temporary measure. The Centers for Medicare & Medicaid Services took administrative action to extend telehealth flexibility through 2023, but some of the changes would need to be made permanent by Congress.

Because the overall effects of the COVID-19 pandemic on the healthcare system have been so widespread, drawing telehealth-specific conclusions as a guide for decision-making is difficult.

The HHS report concludes, citing this difficulty, 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 advised Congress that many of the pandemic-era telehealth reforms should be kept in place at least long enough to be studied. A coalition of over 400 healthcare organizations also signed a letter in July 2021 urging Congress to make Medicare telehealth reforms permanent.

A number of bipartisan bills in Congress are currently in committee to extend various Medicare telehealth reforms, but it is unclear whether any of them will pass.

Utilize Medicare Telehealth Coverage.

You can request telehealth appointments in person, over the phone, or through a patient portal such as MyChart. Depending on your medical needs, you may have several options for receiving care without leaving your home:

Replace a face-to-face meeting. A Medicare telehealth visit allows you to communicate with health care providers over the phone or via video chat in real time. Typically, you can only have a Medicare telehealth visit with a provider you have previously seen in person. However, during a public health emergency, new patients are permitted to have telehealth visits even if they have never seen the provider before.

Check to see if you require an appointment. A virtual check-in allows you to communicate briefly with health care providers to determine whether an in-person visit is required. You can either call or video chat with your healthcare provider in real time, or you can send a message with any relevant audio or video attachments. Phone calls, audio or video recordings, secure text messages, emails, or messages in your patient portal can all be used by providers to respond. Virtual check-ins are only available to exist patients.

Please ask a brief question. An e-visit allows you to send a secure message to health care providers via your patient portal, similar to an email. If you have a quick, non-urgent question, sending a message may be more convenient than waiting on the phone for a provider to answer. E-visits are only available to established patients.