Due to the COVID-19 pandemic, telehealth could become a permanent and cost-saving fixture in Medicare after positive feedback by patients who used virtual visits to avoid meeting face to face.
The use of telehealth was enabled by new regulations that granted waivers for using telemedicine during the pandemic to both Medicare and Medicare Advantage enrollees.
The waivers, issued by the Centers for Medicare and Medicaid Services in March and April, allowed more access to telehealth in the program during the public health emergency, not least by helping enrollees bypass restrictions.
This led to a significant increase in the use of telemedicine, according to the “Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19” report by The Center for Innovation in Medicare Advantage. The center surveyed Medicare enrollees, health plans and providers and found that:
Behavioral health telehealth utilization grew more than other services during the COVID-19 public health emergency. CMS data showed that 60% of Medicare mental health services with psychologists and psychiatrists were provided through telehealth. Among other findings in the report:
- A telemedicine vendor reported a 22-fold increase among its providers.
- One Medicare Advantage plan with existing infrastructure reported a fourfold increase in telemedicine utilization.
- An in-home provider reported 25% of visits shifted to virtual.
- A primary care provider reported 90% of pre-COVID-19 volume shifted to virtual care, with 30% provided via video.
- A health care provider reported growth from 100 tele-visits per week to 10,000 weekly.
Additionally, Medicare beneficiaries seemed mostly pleased with telehealth, particularly the efficiency and convenience of accessing care from the home. Among seniors who used telehealth services for the first time due to the pandemic:
- 91% said they had a favorable telehealth experience, and
- 78% said they were likely to use telehealth again.
But all is not rosy. There are still impediments, such as:
- Medicare and Medicaid alignment for people who are eligible for both.
- Not all beneficiaries have access to telehealth technology and the internet.
- Other restrictive regulations remain in place, such as plan benefit filing.
Better Medicare Alliance, which funded the study, says that to further reduce barriers and increase access to telemedicine, regulators should:
- Rectify portions of the Social Security Act that restrict telehealth usage based on whether the beneficiary’s home is the originating site, whether the patient lives in a rural or urban area, and the provider type and history with the beneficiary.
- Broaden the definition of acceptable telehealth mediums to include audio-only and asynchronous (where the provider and patient are not talking live but via messaging or recorded video).
- Pivot away from fee-for-service payment models for telehealth so that CMS can streamline and further incentivize telehealth use.
What is telehealth?
Telehealth encompasses more than just Facetime or a Zoom meeting with a nurse or doctor. In Medicare, a “telehealth service” is defined in statute as a “professional consultation, office visit, and office psychiatry service, and any additional service specified by the Secretary [of Health and Human Services].”
Medicare also allows the following forms of virtual care:
Telehealth visits – Visits with a provider that uses telecommunications systems between provider and patient.
Virtual visits – Five- to 10-minute check-ins with a practitioner via telephone, or other telecommunications device (smartphone, laptop or tablet) to decide whether an office visit is needed.
E-visits – Communication between a patient and their provider through an online patient portal.
Asynchronous service – Transmission of recorded health history (x-rays, MRIs, etc.) through a secure electronic communications system to a practitioner for evaluation.
Remote patient monitoring – The use of video to collect health information from individuals in one location to electronically transmit to health care providers.