Medicare beneficiaries in urban areas were more likely to use telehealth compared to those in rural areas during the first year of the pandemic, a new report found.
The report, released Wednesday (PDF) by the Department of Health and Human Services Office of Inspector General (HHS OIG), could inform regulators and Congress on what telehealth flexibilities could become permanent. The report also found that one-fifth of beneficiaries relied on audio-only telehealth services, which the Centers for Medicare & Medicaid Services (CMS) has expanded.
“Dually eligible beneficiaries and Hispanic beneficiaries were also more likely than others to use telehealth,” the report said. “In addition, beneficiaries almost always used telehealth from home or other non-healthcare settings.”
OIG looked at Medicare fee-for-service and Medicare Advantage claims from March 1, 2020, through Feb. 28, 2021.
The states with the highest percentage of telehealth users were Massachusetts, Delaware and California. However, the states with the lowest percentage of use included primarily rural areas like Nebraska, Wyoming, Montana and North Dakota.
More than half of all dually eligible beneficiaries (53%) on both Medicare and Medicaid used telehealth in 2020 compared with 40% for those only on Medicare.
“Notably, dually eligible beneficiaries were more likely than Medicare-only beneficiaries to use telehealth regardless of race and ethnicity, and whether they lived in rural or urban areas,” the report said.
OIG also found that 48% of Hispanic Medicare beneficiaries used telehealth compared with 45% of African Americans, Asian/Pacific Islanders and White beneficiaries at 42%.
In addition, almost 1 in 5 beneficiaries relied on six audio-only telehealth services.
“These services consist of telephone calls with a provider for various durations to discuss a beneficiary’s medical condition,” the group said.
The report also delved into certain trends among beneficiaries. It found that 23% of beneficiaries who were 75 years or older used audio-only services compared with only 21% of beneficiaries under 65.
“This pattern is unlike that for all telehealth services and may indicate that older beneficiaries prefer audio-only or have greater difficulty accessing audio-video technology than their younger counterparts,” the report added.
Dual-eligibles as well as Hispanics also were more likely to rely on audio-only telehealth.
Since 2020, CMS has expanded the services available via telehealth and audio-only telehealth. However, the services only remain in place until the end of the COVID-19 public health emergency, which runs out next month but is expected to be extended by HHS for another 90 days.
Congress has passed legislation that will keep the telehealth flexibilities in place for five months after the public health emergency ends. A similar bill that would keep the flexibilities around through December 2024 passed the House at the end of July and remains to be voted on in the Senate.
Lawmakers have said that a key driver in the delays is to give CMS and HHS more time to perform research and determine what flexibilities must be made permanent.
“Telehealth can help increase access to care, especially for beneficiaries who are medically underserved or face barriers to accessing in-person care,” the report said. “CMS should take steps to promote the use of telehealth and use telehealth to address the goals of its health equity strategy, as appropriate.”