According to CMS data, there was a 63-fold increase in telehealth utilization in 2020 by Medicare enrollees. (Photo: fizkes/Shutterstock.com)
A new report from the U.S. Department of Health and Human Services (HHS) has provided a better understanding of the massive increase in the utilization of telehealth services during the initial months of the COVID-19 pandemic. The study found that there was a 63-fold increase in telehealth utilization in 2020 by Medicare enrollees, from approximately 840,000 telehealth visits in 2019 to nearly 52.7 million in 2020.
"Compared with <1% telehealth use in 2019 across all categories, telehealth increased to 8.3% of all primary care visits and 2.6% of specialist visits in 2020," the study said. "Visits to behavioral health specialists saw the largest increase in telehealth use during the pandemic, with 38.1% of all visits to these providers delivered by telehealth, compared with 1% in 2019."
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As other reports have noted, the ending of lockdowns and the re-opening of health care clinics resulted in a decrease in telehealth utilization from its peak in the early months of the pandemic, but use remains much higher than the numbers seen pre-pandemic.
A change in reimbursement
The early months of the pandemic threatened to have a devastating effect on health care delivery—even outside the incidence of infection, illness, and death from COVID-19. With the U.S. health system focused on dealing with the pandemic and many clinics closed down to prevent spread of the virus, millions of patients were unable to see providers for preventive health services or for ongoing treatment of chronic disease.
On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced new policies that would reimburse providers for telehealth services at the same level as payments for in-person visits. "This set of Medicare telehealth flexibilities allowed broader use of telehealth during the pandemic and were intended to ensure beneficiaries had continued access to care despite the pandemic,' the report said.
The changes, augmented by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, expanded rules that had restricted telehealth funding to primarily rural health care providers. The new rules allowed many urban providers of CMS services to offer telehealth services for the first time, the study noted. But even with the sharp increase in telehealth utilization, there was a 11% decrease overall in Medicare clinician visits in 2020, compared to 2019.
Behavioral health utilization grew, but barriers remain
The study found that the shift to telehealth was both larger and more long-lasting in the area of behavioral health. For 2020, one-third of all behavioral health visits were remote; by the end of the year, telehealth visits were equal to in-person visits for Medicare behavioral care patients. And audio-only telehealth, an option for those with limited access to technology, saw far higher numbers in this area than was seen for other types of care.
However, the use of telehealth continues to be limited in some ways—primarily through lack of access to the technology needed. The high use of audio-only services for rural patients might be a sign of this, and the study also found that rural states overall saw lower rates of increase for telehealth use after the pandemic began, compared to states with large urban populations—even though telehealth has been promoted in rural states for years.
"Lower telehealth use by rural beneficiaries may be due to limitations in broadband access and challenges with Internet availability and affordability," the study said.
Racial disparities were also found: overall, Black people had slightly lower telehealth use than White people. "A survey of Medicare beneficiaries during the pandemic found older adults, minorities, those with a lower income, and non-English speakers had less availability of telehealth equipment and were less likely to use telehealth," the report said.
The study concluded by saying the data on Medicare telehealth utilization could help shape future decisions by regulators and policymakers. ""This report provides valuable insights into telehealth usage during the pandemic," said CMS Administrator Chiquita Brooks-LaSure. "CMS will use these insights – along with input from people with Medicare and providers across the country – to inform further Medicare telehealth policies."
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