Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others To Use Telehealth During the First Year of the COVID-19 Pandemic

WHY WE DID THIS STUDY

The COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries access health care. In response, the Department of Health and Human Services (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 and in different locations, including in urban areas and from the beneficiary's home.

In a companion report, OIG found that the use of telehealth increased dramatically during the first year of the pandemic. More than 28 million—about 2 in 5—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.

This data brief expands on that analysis and examines the characteristics of beneficiaries who used telehealth during the first year of the pandemic. This information sheds light on how the temporary expansion of telehealth affected different groups of beneficiaries. 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.

This data brief includes beneficiaries in Medicare fee-for-service and Medicare Advantage. This report is part of a series that examines the use of telehealth in Medicare and identifies program integrity concerns related to telehealth during the pandemic.

HOW WE DID THIS STUDY

This analysis focuses on Medicare beneficiaries who used telehealth services during the first year of the pandemic, from March 1, 2020, to February 28, 2021. We based this analysis on Medicare fee-for-service claims data, Medicare Advantage encounter data, and data from the Medicare Enrollment Database.

WHAT WE FOUND

Beneficiaries in urban areas were more likely than those in rural areas to use telehealth during the first year of the pandemic. Beneficiaries in Massachusetts, Delaware, and California were more likely than beneficiaries in some other States to use telehealth. Dually eligible beneficiaries (i.e., those eligible for both Medicare and Medicaid), Hispanic beneficiaries, younger beneficiaries, and female beneficiaries were also more likely than others to use telehealth. In addition, beneficiaries almost always used telehealth from home or other non-health-care settings. Furthermore, almost one-fifth of beneficiaries used certain audio-only telehealth services, with the vast majority of these beneficiaries using these audio-only services exclusively. Older beneficiaries were more likely to use these audio-only services, as were dually eligible and Hispanic beneficiaries.

WHAT WE CONCLUDE

As CMS, HHS, Congress, and other stakeholders consider permanent changes to Medicare telehealth services, it is important that they balance concerns about issues such as access, quality of care, health equity, and program integrity. Doing so will ensure that the benefits of telehealth are realized while minimizing risk. The data presented in this report demonstrate how the temporary expansions improved access to telehealth for Medicare beneficiaries, particularly for those who are medically underserved. Understanding who benefited from increased access and how different groups used telehealth can inform policymakers and stakeholders as they make decisions about telehealth.

Accordingly, we recommend that CMS: (1) take appropriate steps to enable a successful transition from current pandemic-related flexibilities to well-considered long-term policies for the use of telehealth for beneficiaries in urban areas and from the beneficiary's home, (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 to advance health care equity. CMS did not explicitly indicate whether it concurred with our four recommendations.