In September 2022, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) published a data brief that found there were certain Medicare beneficiaries that were more likely to use telemedicine in the first year of the COVID-19 pandemic than others. According to the data brief, both HHS and the Centers for Medicare and Medicaid Services (CMS) took steps toward expanding access to telehealth for Medicare beneficiaries, including allowing them to use telehealth for a wide range of services in different locations – including urban areas and from the beneficiary’s home.
Telehealth services can include care visits, such as office visits, behavioral health services, nursing home visits, and home visits, among others. A group of services known as “virtual care services” is always provided remotely, such as a telephone call with a provider to discuss a beneficiary’s medical condition. Prior to the pandemic, Medicare beneficiaries were limited in their ability to use telehealth, including only from medical facilities located in rural areas. However, during the pandemic, CMS expanded the use to include allowing beneficiaries to use telehealth to access a wide variety of services in different locations – including their own home. The types of services available to beneficiaries via telehealth during the pandemic increased from 118 to 264 different service types.
The HHS OIG analysis focused on Medicare beneficiaries who used telemedicine services from March 1, 2020 to February 28, 2021, using Medicare fee-for-service claims data, Medicare Advantage encounter data, and data from the Medicare Enrollment Database. Ultimately, HHS OIG found that beneficiaries located in an urban area were more likely than those in rural areas to use telehealth. Additionally, beneficiaries who were dually eligible, Hispanic, younger, and female were more likely than others to use telehealth.
Nearly 20% of beneficiaries used certain audio only telehealth services, and the majority of those used them exclusively. Older, Hispanic, and dually eligible beneficiaries were more likely to use audio only services. Additionally, beneficiaries almost always used telehealth from home or other non-healthcare settings.
Urban Area Increase
Prior to the pandemic, beneficiaries in urban areas did not really have access to telehealth. However, 45% of beneficiaries in urban areas used telehealth during the first year of the pandemic, compared to the 33% of beneficiaries in rural areas that used telehealth. Beneficiaries who live in rural areas may have less access to broadband connectivity, and rural health care providers may also face challenges providing telehealth to their patients due to expensive equipment and internet connectivity.
Dually Eligible and Younger Beneficiaries More Likely to Use Telehealth
Beneficiaries dually eligible for Medicare due to age or disability and Medicaid due to income were more likely to use telemedicine than Medicare-only beneficiaries. A little more than half of dually eligible beneficiaries (53%) as compared to 40% of Medicare-only beneficiaries.
Additionally, beneficiaries under age 65 were more likely than beneficiaries in other age groups to use telehealth, with 49% of beneficiaries under age 65 using telemedicine during the first year of the pandemic. Beneficiaries under age 65 also tend to qualify for Medicare due to a disability and are often dually eligible. Beneficiaries between 65 and 74 were least likely to us telehealth (38% of beneficiaries) while 47% of beneficiaries 75 and older used it.
HHS OIG Recommendations
As the agency often does, HHS OIG provided recommendations to CMS as CMS, HHS, and Congress consider permanent changes to Medicare telehealth services. HHS OIG notes that the stakeholders need to balance concerns about access, quality of care, cost, health equity, and program integrity to ensure the benefits of telehealth are realized with minimized risk.
HHS OIG therefore recommended CMS take four actions: (1) take appropriate steps to allow for a successful transition from the current pandemic-related telehealth flexibilities to well-considered long-term policies for telehealth; (2) temporarily extend the use of audio-only telehealth services and evaluate their impact; (3) require a modifier to identify all audio-only telehealth services provided in Medicare; and (4) use telehealth as a way to advance health care equity.
CMS did not explicitly concur with the four recommendations.