CMS telehealth expansion benefits disadvantaged neighborhoods, study in Health Affairs finds

Photo: Geber86/Getty Images

At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services expanded telehealth coverage to patients across the country, and new data published in Health Affairs shows that people in socioeconomically disadvantaged neighborhoods benefitted the most, increasing the odds of usage among minority patients and people living in metropolitan areas.

Researchers from Johns Hopkins University looked at about 30 million Medicare fee-for-service claims from 2019 to 2021 and found stark differences before and after CMS' waiver. Before the waiver, just 0.42% of patients had recorded at least one outpatient telehealth visit, a number that held steady across nearly all socioeconomic subgroups, though rural patients were about four times more likely to use telehealth.

After the waiver, the share of patients with at least one outpatient telehealth visit climbed to about 10%, and those in disadvantaged areas were the most likely to utilize it. Women, Asians and Hispanics were the subgroups most likely to take advantage of the waivers.

WHAT'S THE IMPACT?

The findings were a surprise to researchers. Prior studies of telehealth use before and during the pandemic uncovered disparities in usage that were dependent on demographic factors such as race, income and geography – showing an inverse association of socioeconomic status with telehealth use. The latest study, however, showed that expanded access did not worsen racial disparities in the Medicare population, as had been feared.

Telehealth was a critical lifeline for people in the early days of the COVID-19 pandemic, though this was especially true for Medicare beneficiaries, with more than 28 million beneficiaries using virtual health services during the first year of the public-health emergency, according to a March report from the Department of Health and Human Services' Office of the Inspector General.

With more than two in five Medicare recipients using the technology, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did in the prior year.

Telehealth use peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to receive 12% of their services during that first year. They employed telehealth most commonly for office visits, which accounted for just under half of all telehealth services used in 2020.

Authors of the new study advocated for legislation that would extend telehealth reimbursement beyond the national public health emergency, which is set to expire eventually, and the waivers along with it. Researchers said such a move would improve accessibility for those at greater socioeconomic disadvantage.

THE LARGER TREND

The pandemic created significant challenges for how Medicare beneficiaries accessed healthcare. In response, HHS and CMS took a number of actions to temporarily expand access to telehealth for Medicare beneficiaries. 

CMS allowed beneficiaries to use telehealth for a wide range of services; it also allowed beneficiaries to use telehealth in different locations, including in urban areas and from the beneficiary's home.

One of HHS' main conclusions, aside from telehealth's ability to provide critical services, is that the technology has long-term potential to increase access for Medicare beneficiaries specifically – especially for services such as mental health treatment, which showed high utilization in 2020 and beyond.

These findings are important for CMS, Congress and other stakeholders to take into account as they consider making changes to telehealth in Medicare, according to HHS. For example, CMS could use the findings to inform changes to the services that are allowed via telehealth on a permanent basis.

Telehealth still enjoys widespread popularity among patients, even though its appeal has dimmed somewhat. A December 2021 Rock Health survey found that in 2020 53% of respondents were more satisfied with live video virtual care than in-person interactions. This satisfaction decreased somewhat in 2021, however, with just 43% of respondents reporting the same.

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