Touting the early impact of CMS’ expansion of Medicare telehealth during the pandemic, Administrator Seema Verma reported that in the last week of April, nearly 1.7 million beneficiaries received telehealth services—compared to about 13,000 per week leading up to the crisis.
In a recent Health Affairs commentary, Verma, who runs the Centers for Medicare & Medicaid Services (CMS), recounted that in response to the pandemic that forced the shutdown of many in-person services, the federal agency announced several temporary rules and waivers to expand the scope of Medicare telehealth services, aiming to making it easier for more types of healthcare providers to offer a wider range of telehealth services to beneficiaries across the country. For example, she wrote, one of the first steps CMS took in response to the COVID-19 public health emergency was to temporarily expand the scope of Medicare telehealth to allow Medicare beneficiaries across the country—not just in rural areas—to receive telehealth services from any location, including their homes. CMS also added 135 allowable services, more than doubling the number of services that beneficiaries could receive via telehealth.
Additionally, CMS has temporarily expanded the types of healthcare providers that can offer telehealth to broaden patient access to care, and also removed other barriers that may limit beneficiary access to telehealth services, such as interactive audio-video technology.
Beyond the 1.7 million beneficiaries who received telehealth services the last week of April, Verma pointed out several other examples of how access to virtual care services has greatly improved during the pandemic:
- In total, over 9 million beneficiaries have received a telehealth service during the public health emergency, mid-March through mid-June. Telemedicine services include services on the Medicare telehealth list including audio-only visits, as well as virtual check-ins and e-visits.
- According to Medicare fee-for-service claims data, beneficiaries, regardless of whether they live in a rural or urban area, are seeking care during the pandemic through telemedicine services. In rural areas, 22 percent of beneficiaries used telehealth services, and 30 percent of beneficiaries in urban areas did so.
- There has been regional variation in use of telemedicine during the pandemic. For example, beneficiaries in northeastern states—New Jersey, Connecticut, Maryland, Delaware, Rhode Island and Massachusetts—have a higher percentage of telemedicine services (over 35 percent of beneficiaries in those states received a telehealth service) compared to those in states in the north central part of the country—South Dakota, Nebraska, North Dakota, Montana and Idaho (less than 17 percent of beneficiaries in those states received a telehealth service). The regional variation could be due to the extent to which health care providers in those states offered telemedicine services and whether patients sought out care via that option, Verma offered.
- Across all age groups, 25 to 34 percent of beneficiaries have received a telemedicine service (34 percent among beneficiaries below the age of 65, 25 percent among beneficiaries between ages 65 to 74, 29 percent among beneficiaries between ages 75 to 84, and 28 percent among beneficiaries older than 85).
- Dually eligible beneficiaries (low-income beneficiaries that qualify for both Medicare and Medicaid) have had higher rates of telemedicine use: 34 percent of dually eligible beneficiaries have had a telemedicine service, compared to 26 percent of Medicare-only beneficiaries.
- There are no significant differences by race or ethnicity among beneficiaries who received telemedicine services (25 percent among Asians, 29 percent among Blacks, 27 percent among Hispanics, 28 percent among Whites, and 26 percent among others).
- Evaluation and management (E/M) visits, or office visits, have been the most common form of telehealth, with nearly 5.8 million beneficiaries receiving an E/M telehealth visit since the public health emergency started. Additionally, 38 percent of beneficiaries who had an E/M visit furnished during the public health emergency did so via telehealth
- Another area where telehealth has been used frequently has been mental health services with a psychiatrist or psychologist: approximately 460,000 beneficiaries (or 60 percent) receiving this care through telehealth.
- The use of audio-only telehealth services has also been shown to be helpful for the Medicare population during the public health emergency, as many patients may not have access to or feel comfortable using video technology. Over 3 million beneficiaries have received telehealth services via traditional telephone.
- 26 percent of beneficiaries who received nursing home visits did so by telehealth
Moving forward, Verma wrote that “CMS is reviewing the temporary changes we made and assessing which of these flexibilities should be made permanent through regulatory action. As part of our review, we are looking at the impact these changes have had on access to care, health outcomes, Medicare spending, and impact on the healthcare delivery system itself.”
To that end, hundreds of healthcare organizations are urging Congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. A recent letter from 340 industry groups emphasized the importance of providing telehealth services during the pandemic—care that would not have been able to be delivered without the loosening of prior restrictions.
Importantly, those groups noted that statutory restrictions within the Social Security Act and that the authorities granted to HHS and CMS through recent coronavirus legislation are limited to the COVID-19 public health emergency period, meaning that “Congress must act to ensure that the Secretary has the appropriate flexibility to assess, transition, and codify any of the recent COVID-19-related telehealth flexibilities and ensure telehealth is regulated the same as in-person services.”
What’s more, a group of 23 healthcare stakeholders—representing a broad spectrum of health plans, providers, consumer advocates and health quality experts from the public, private and non-profit sectors—has created the Taskforce on Telehealth Policy to make recommendations for policymakers on how to maximize the benefits of telehealth services while maintaining high standards for care and healthcare delivery. Officials say the taskforce has just 9 weeks to formalize its recommendations for remote healthcare delivery nationwide. The coalition was convened by the Alliance for Connected Care, National Committee for Quality Assurance, and the American Telemedicine Association.
During an early June event, Verma remarked that expanded access to telemedicine should continue after the pandemic wanes, and that federal officials are examining ways to act without waiting for legislation from Congress. “I can’t imagine going back,” Verma told the news publication STAT, a statement that made headlines across the industry.
At the same time, there does appear to be data revealing that with healthcare providers reopening their doors for in-person visits, patients are going back to choosing that modality over telehealth. A recent Commonwealth Fund data showed that telehealth visits made up about 14 percent of visits during the week of April 19, but that number had fallen to 7 percent in mid-June. Health policy researchers did emphasize that despite the decline, telehealth use is still substantially higher than it was pre-pandemic.
