HHS shows 63-fold increase in Medicare telehealth use during the pandemic

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Telehealth utilization increased 63-fold during the pandemic, according to a new report from the U.S. Department of Health and Human Services. Behavioral health providers saw the highest telehealth utilization, in a 32-fold increase, HHS said.

In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8% of visits to primary care providers and 3% of visits to other specialists.  

WHY THIS MATTERS

HHS is using the report to evaluate whether and which services should be permanently added to the Medicare telehealth services list. Services added temporarily during the public health emergency will remain in place through December 31, 2023 to give time for an evaluation. 

While utilization of telehealth services increased and improved access to services for many beneficiaries, more research is needed to understand the impact on quality of care and why certain beneficiaries used less telehealth than others, HHS said. 

Telehealth services were accessed more in urban areas than rural communities, and Black Medicare beneficiaries were less likely than white beneficiaries to utilize telehealth, the report shows. The report, which was produced by researchers in HHS's Office of the Assistant Secretary for Planning and Evaluation (ASPE), analyzed Medicare fee-for-service data in 2019 and 2020.

Through waivers and other regulatory action, Medicare visits conducted through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million, the ASPE report said. 

States with the highest use of telehealth in 2020 included Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut. States with the lowest use of telehealth in 2020 included Tennessee, Nebraska, Kansas, North Dakota and Wyoming. 

The Centers for Medicare and Medicaid Services also released a new snapshot showing the number of people with Medicare who utilized telemedicine services between March 1, 2020 and February 28, 2021. The snapshot includes Medicare fee-for-service claims data, Medicare Advantage  encounter data, and Medicare enrollment information.

THE LARGER TREND

To help beneficiaries maintain access to care amid stay-at-home orders to reduce COVID-19 related exposure, CMS used emergency waiver authorities enacted by Congress, as well as existing regulatory authorities, to implement policies expanding access to telehealth services during the pandemic. 

These included waiving several statutory limitations, such as geographic restrictions, and allowing beneficiaries to receive telehealth in their home. 

Outside of the public health emergency, Medicare is generally restricted to payment for telehealth services in certain, mostly rural areas, and when beneficiaries leave their home and go to a clinic, a hospital or another type of medical facility for the service. 

There were some exceptions for beneficiaries with end-stage renal disease, stroke and other conditions. Additionally, the HHS Office for Civil Rights relaxed enforcement of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 privacy requirements for video conferencing.

In the physician fee schedule rule released last month CMS announced that for the first time outside of the COVID-19 PHE, Medicare would pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via interactive video-based telehealth, including audio-only telephone calls. 

Additionally, CMS permanently eliminated geographic barriers to allow patients in their homes to access telehealth services for diagnosis, evaluation and treatment of mental health disorders, including via audio-only communications technology. These provisions were included in the Consolidated Appropriations Act of 2021.

ON THE RECORD

"This report provides valuable insights into telehealth usage during the pandemic," said CMS Administrator Chiquita Brooks-LaSure. "CMS will use these insights – along with input from people with Medicare and providers across the country – to inform further Medicare telehealth policies."

"During the COVID-19 pandemic, various telehealth flexibilities enabled patient access to their providers," said HHS Acting Assistant Secretary for Planning and Evaluation Rebecca Haffajee. "Pre-pandemic telehealth visits for Medicare beneficiaries went from hundreds of thousands to tens of millions, with many utilizing telehealth for the first time.  Today's report offers a detailed data analysis on important trends for policymakers."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com