Medicare patients in poor neighborhoods benefited most from CMS telehealth expansion, study finds

Expanding Medicare coverage of telemedicine during the pandemic increased odds of use among minority populations and patients in metropolitan areas, a new study found.

The study, overseen by Johns Hopkins University, was published in Health Affairs and looked at 30 million Medicare claims between 2019 and 2021. The Centers for Medicare & Medicaid Services (CMS) expanded telemedicine coverage to patients across the country in March 2020. Prior to the waiver, telemedicine was only covered for beneficiaries in designated rural areas or specific medical facilities. 

Before the CMS waiver, .42% of patients had at least one outpatient telemedicine visit, the study found. Though there were no notable differences in use between people in the most and the least disadvantaged neighborhoods, odds of use were more than four times higher in rural than in metropolitan areas. When adjusted for demographic variables, elderly and Black patients were less likely to use telemedicine, while females and those in rural areas were more likely to. 

However, after the waiver, nearly 10% of patients had at least one outpatient telemedicine visit, with the highest odds of utilization among those in the most disadvantaged neighborhoods and those in metropolitan areas. Females, Asians and Hispanics were also more likely to use telemedicine in the adjusted model.

In the past, studies on telemedicine use before and during the pandemic found disparities in use depending on demographics like race, geographic location and household income. The latest study shows expanded access did not worsen racial disparities in the Medicare population, the authors noted. 

“These findings were surprising, as prior studies have reported a consistent inverse association of socioeconomic status with telemedicine use” during COVID-19, the study concluded. The study shows that an increase in telemedicine coverage did not contribute to disparities the way some had feared. 

The authors called on legislation to extend telemedicine reimbursement beyond the national public health emergency, which will inevitably expire, and for improved accessibility, particularly for those at a greater socioeconomic disadvantage.