The Department of Health and Human Services (HHS), through the Assistant Secretary for Planning and Evaluation (ASPE), released a report on Medicare beneficiary telehealth utilization during the COVID-19 pandemic (press release). The report analyzes Medicare fee-for-service (FFS) claims data from January through May 2020 and addresses how the telehealth flexibilities helped maintain access to health services during the public health emergency.
Additional details from the report follow:
- Methods – ASPE examined Part B claims data for primary care services, which included evaluation and management (E&M), preventive services, and advanced care planning. The agency details that telehealth services were identified using the appropriate Current Procedural Terminology (CPT) code or the modifier code 95 for services that could be provided either in-person or through telehealth. ASPE notes that they did not separately examine the use of communication technology-based services such as virtual check-ins.
The report evaluates the number of primary care services provided, the proportion of services provided by telehealth, and the rate of services per Medicare FFS beneficiary. Primary care services were also broken by beneficiary type (FFS, dually enrolled, and high-spending) and by geography.
- Findings – HHS highlights the following as the main findings from the report:
- 43.5 percent of primary care visits were furnished via telehealth in April, compared to only 0.1 percent of primary care visits furnished via telehealth in February. Telehealth visits in April reached approximately 1.28 million visits per week.
- In May, telehealth visits dropped to 30 percent of all primary care services, with some providers resuming in-person visits. However, the rate of in-person visits has not reached its pre-pandemic levels. HHS notes that this continued use of telehealth services, as in-person services resume, may signal a beneficiary desire for the flexibilities to persist.
- Telehealth was used more greatly in urban areas compared to rural areas. Providers in urban counties saw a much larger growth in telehealth visits as a proportion of all primary care visits than rural counties, with the greatest use of telehealth occurring earlier in the public health emergency. HHS asserts that this may be due to greater broadband access in urban counties.
- Medicare FFS beneficiaries, dually-enrolled beneficiaries, and high-cost beneficiaries all similarly utilized telehealth services during the pandemic.
- Summary – ASPE concludes that the telehealth flexibilities implemented during the public health emergency played a critical role in maintaining access to primary care services. The agency also suspects that the sustained use of telehealth after in-person visits resumed may suggest a continued demand for telehealth in the Medicare program after the pandemic ends.
- Future Research – The agency notes that while this information could inform future policy decisions on making the telehealth flexibilities permanent, additional analysis is needed. ASPE suggests that future research could examine Medicare telehealth use by: 1) provider type; 2) beneficiary characteristics including race and ethnicity to assess potential disparities; 3) geography; and 4) types of services and settings during the public health emergency. The agency also acknowledges that the impact of relaxing HIPPA requirements will need to be evaluated to continue the use of multiple tele-video platforms.
Finally, ASPE asserts that the key question for future research will be to assess if Medicare telehealth flexibilities were effective in mitigating potential adverse health and cost impacts from COVID-19, including foregone health care. Additionally, research could focus on whether telehealth improved access to care and health outcomes for underserved beneficiaries.
The report also contains Appendix A, which summarizes the changes in the Medicare telehealth benefit during the public health emergency; Appendix B, the primary care claims codes that were analyzed; and Appendix C, which provides the weekly primary care services data broken down between in-person visits and telehealth visits.