The use of telehealth escalated in 2020 during the COVID-19 pandemic as patients sought out ways to get medical care while staying in the safety of their homes.
There was a sharp uptake in telehealth use among seniors, with telephones playing a crucial role in connecting Medicare patients to care, according to an analysis from the Kaiser Family Foundation of Centers for Medicare & Medicaid Services (CMS) survey data.
Among the 33.6 million Medicare beneficiaries with a usual source of care who reported that their provider currently offers telehealth appointments, nearly half (45%) said they had a telehealth visit with a doctor or other health professional between the summer and fall of 2020. This translates to just over 1 in 4 (27% or 15 million) of all beneficiaries in both traditional Medicare and Medicare Advantage using telehealth, KFF found.
That represents a substantial increase in use since before the pandemic.
"Our finding that, among beneficiaries whose provider offers telehealth, a greater share of those with disabilities, with low incomes, and in communities of color have used telehealth suggests that the temporary expansion of telehealth coverage may be helping some of Medicare’s more disadvantaged populations continue to access needed care," KFF researchers wrote in the report.
Nearly two-thirds (64%) of Medicare beneficiaries said their provider currently offers telehealth appointments, up from 18% pre-pandemic.
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Prior to the pandemic, the use of telehealth among traditional Medicare beneficiaries was extremely low, with only 0.3% of traditional Medicare beneficiaries enrolled in Part B using telehealth services in 2016, accounting for only 0.4% of traditional Medicare Part B spending, KFF reported.
But nearly a quarter of Medicare beneficiaries (23%) say they don’t know if their provider offers telehealth appointments, and this percentage is larger among beneficiaries who live in rural areas (30%), KFF found.
This finding highlights that efforts to increase awareness of covered telehealth services under Medicare during the public health emergency could help to broaden its reach, the researchers wrote.
Telehealth use between the summer and fall of 2020 was higher among Medicare beneficiaries under the age of 65 who qualify for Medicare due to a long-term disability (53%), beneficiaries enrolled in both Medicare and Medicaid (55%), Black (52%) and Hispanic (52%) beneficiaries and those with six or more chronic conditions (56%), according to the analysis.
KFF's analysis found no difference in reported rates of telehealth use between beneficiaries in traditional Medicare and Medicare Advantage (44% and 45%, respectively).
Interestingly, telephones played a key role in connecting seniors to medical care. For those Medicare beneficiaries who had a telehealth visit, more than half (56%) used a telephone only, while a smaller share had a telehealth visit via video (28%) or both video and telephone (16%).
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The share of Medicare beneficiaries who had a telehealth visit using telephone only was higher among those age 75 and older (65%), Hispanic beneficiaries (61%), those living in rural areas (65%) and those enrolled in both Medicare and Medicaid (67%).
This may be related to the fact that while more than 8 in 10 Medicare beneficiaries report having access to the internet (83%), smaller shares say they own a computer (64%) or a smartphone (70%), KFF found.
Under Medicare's existing telehealth benefit, a telehealth visit must be conducted with two-way audio/video communications.
"Given that the majority of Medicare beneficiaries in our analysis reported accessing telehealth services by telephone only, an expanded telehealth benefit that requires two-way video communication could be a barrier to care for subgroups of the Medicare population that relied more heavily on telephones than video-capable devices during the pandemic," the KFF researchers wrote.
During the COVID-19 public health emergency, the federal government waived certain restrictions on Medicare coverage of telehealth services for traditional Medicare beneficiaries. The waiver, effective for services starting on March 6, 2020, significantly loosened coverage restrictions for telehealth under traditional Medicare during the public health emergency.
Congress debating telehealth's future
But the long-term future of payment policies for telehealth and coverage flexibilities is still up in the air.
Currently, policymakers are considering a variety of proposals to expand some or all of the existing flexibilities surrounding telehealth services under Medicare beyond the public health emergency.
The telehealth-related bills that have been introduced in Congress include proposals to permanently expand telehealth access, including the Protecting Access to Post-COVID–19 Telehealth Act of 2021, the Telehealth Expansion Act of 2020, which would expand Medicare-covered mental health services and evaluation and management services administered via telehealth and a bill expanding the scope of providers eligible for payment for telehealth services covered by Medicare.
Other bills are aimed at assessing the impact of expanded telehealth services on the quality of patient care and program spending.
The U.S. House of Representatives recently introduced a bill to extend the use of audio-only telehealth services for seniors enrolled in Medicare Advantage plans and for members of the Program of All-Inclusive Care for the Elderly (PACE). The bill has generated support from both healthcare organizations and industry associations.
In recent Senate and House committee hearings, legislators have voiced support for making telehealth flexibilities enacted during the COVID-19 pandemic permanent to help close gaps in care.
Going forward, one major issue is whether to permanently establish payment parity for virtual care at the same rate as in-person care.
However, Medicare Payment Advisory Commission (MedPAC) has recommended (PDF) that Medicare continue a modified version of expanded telehealth coverage for another year or two after the public health emergency ends, giving Medicare time to assess the effects of telehealth use on total costs, access, and quality of care.
"Given that the temporary waiver of restrictions on coverage of telehealth services under Medicare will come to an end with the expiration of the public health emergency, the question of whether and how to ensure continued access to these services, while balancing concerns about quality of care and spending, looms large," KFF researchers wrote.
HHS renewed the COVID-19 public health emergency declaration April 21.