Urban Medicare beneficiaries more likely to use telehealth than rural patients, OIG finds

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Medicare beneficiaries who live in urban areas, or who are young or female, were more likely to use telehealth than other patients during the first year of the COVID-19 pandemic, according to new data from the Department of Health and Human Services' Office of the Inspector General.

The pandemic created new challenges for Medicare beneficiaries in accessing healthcare, and so HHS and the Centers for Medicare and Medicaid Services responded, taking actions to temporarily expand telehealth access. CMS allowed beneficiaries to use telehealth for a wide range of services and in different locations, including in urban areas and from the beneficiary's home.

In the new report, OIG found that the use of telehealth increased dramatically during the first year of the pandemic. More than 28 million – about two in five – Medicare beneficiaries used telehealth that first year. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did in the prior year.

Beneficiaries in urban areas were more likely than those in rural areas to use telehealth. Dually eligible, Hispanic, younger and female beneficiaries were also more likely to use it.

Almost one fifth of beneficiaries used certain audio-only telehealth services; the vast majority of these beneficiaries used them exclusively. Older patients, meanwhile, were more likely to use certain audio only services, as were dually eligible and Hispanic beneficiaries.

WHAT'S THE IMPACT?

Dually eligible patients were more likely to use telehealth regardless of race, ethnicity and where they lived, with about 53% of such beneficiaries using remote care technology in 2020 compared to just 40% of those who are only on Medicare.

At 48%, Hispanic Medicare beneficiaries were more likely to use telehealth than African Americans (45%), Asian/Pacific Islanders (42%) and Caucasians (42%).

Age also uncovered some patterns, with 23% of those 75 or older using audio-only services, while just 21% of those under 65 used audio-only telehealth. Hispanics and dual-eligibles were also more likely to rely on audio-only services.

OIG said this information will help CMS, HHS, Congress and other stakeholders understand who benefited from the expansion and make decisions about whether some of the temporary changes should become permanent. It can also inform efforts aimed at ensuring that all beneficiaries have appropriate access to telehealth, OIG said.

THE LARGER TREND

Understanding who benefited from increased access and how different groups used telehealth can inform policymakers and stakeholders as they make decisions about telehealth, OIG said.

The agency is recommending that CMS take steps to enable a successful transition from current pandemic-related flexibilities to long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary's home. 

The group is also suggesting HHS temporarily extend the use of audio-only telehealth services and evaluate their impact, as well as require a modifier to identify all audio-only telehealth services provided in Medicare.

CMS has not explicitly indicated whether it concurred with these recommendations.

The House passed a bill in July that extends telehealth flexibilities through 2024. The bill would allow federally qualified health centers and rural health clinics to serve as the distant site (the location of the healthcare practitioner); it would allow beneficiaries to receive telehealth services at any site, regardless of type or location; it would allow any type of practitioner to furnish telehealth services, subject to approval by CMS; and it would continue coverage for audio-only evaluation and management and behavioral health services.

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