Telehealth usage varies widely among Medicare beneficiaries

Photo: Kilito Chan/Getty Images

More than a quarter of Medicare beneficiaries used telehealth services during the summer and fall in 2020, but usage varied significantly when factoring in metrics such as age and race, finds a new report from Kaiser Family Foundation.

In one sense, the uptick in telehealth utilization patterns isn't surprising. Virtual healthcare has experienced a surge during the COVID-19 pandemic among both Medicare beneficiaries and privately insured patients. While it was once limited primarily to rural areas, with restrictions on who could receive the services and which providers could be paid to deliver them, these restrictions have been eased during the ongoing public health emergency.

Soon after the federal government declared the PHE in early 2020, Congress and the Centers for Medicare and Medicaid Services expanded traditional Medicare's coverage of telehealth services in order to make it easier for beneficiaries to get medical care and minimize their exposure to the coronavirus in healthcare settings. 

When the public health emergency ends, however, Medicare's coverage of telehealth services will revert back to the more limited availability that existed before the pandemic, unless policymakers take action to extend the expanded coverage.

In the meantime, usage patterns show wide variation when examined by demographic and other factors.

WHAT'S THE IMPACT?

Among the vast majority of Medicare beneficiaries with a usual source of care (95%), such as a doctor, another health professional a or clinic, nearly two-thirds (64%, or 33.6 million) say their provider currently offers telehealth appointments, up from 18% who said their provider offered telehealth before the pandemic. But 23% of Medicare beneficiaries say they don't know if their provider offers telehealth appointments, and this percentage is larger among beneficiaries who live in rural areas (30%).

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 one in four (27%, or 15 million) of all community-dwelling beneficiaries in both traditional Medicare and Medicare Advantage using telehealth during that time.

Reported usage among those who said their provider offers telehealth was higher among Medicare beneficiaries under 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%). 

For some groups, including Medicare-Medicaid enrollees and those with multiple chronic conditions, higher rates of telehealth use may be related to higher use of healthcare overall. There was no difference in reported rates of telehealth use between beneficiaries in traditional Medicare and Medicare Advantage (44% and 45%, respectively).

Among Medicare beneficiaries who had a telehealth visit, a majority (56%) report accessing care using a telephone only, while a smaller share had a telehealth visit via video (28%) or both video and telephone (16%).

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%).

THE LARGER TREND

Before the pandemic, only physicians and certain other practitioners – such as physician assistants, clinical social workers and clinical psychologists – were eligible to receive Medicare payment for telehealth services provided to eligible beneficiaries in traditional Medicare, and they must have treated the beneficiary receiving the services in the last three years. 

During the public health emergency, any healthcare professional that is eligible to bill Medicare for professional services can provide and bill for telehealth, and does not need to have previously treated the beneficiary. Also, federally qualified health centers and rural health clinics are allowed to provide telehealth services to Medicare beneficiaries during the pandemic. These settings were not authorized as providers of telehealth services for Medicare beneficiaries prior to the virus outbreak.

In the time before COVID-19, Medicare's payment for a telehealth service was the same, regardless of whether it was provided in a non-facility setting, such as a clinician's office, or in a facility setting, such as a hospital outpatient department. The payment rate was based on the lower amount paid to facility-based providers for a service delivered in person.

The rationale for using the lower facility payment amount for telehealth services was that practice expenses for the delivery of telehealth services should be lower than those for an in-person visit.

During the public health emergency, however, Medicare pays for telehealth services, including those delivered via audio-only telephone, as if they were administered in person, with the payment rate varying based on the location of the provider.

That means Medicare pays more for a telehealth service provided by a doctor in a non-facility setting than by a doctor in a hospital outpatient department. It also means that during the pandemic, doctors in non-facility settings are receiving a higher payment for services provided by telehealth than they did beforehand.

Medicare Advantage plans have been able to offer additional telehealth benefits not covered by traditional Medicare outside of the public health emergency, including telehealth visits provided to enrollees in their own homes and services provided outside of rural areas. In 2021, virtually all Medicare Advantage plans (98%) offer a telehealth benefit, according to KFF.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com