Medicare Beneficiaries Flock to Telehealth Visits

Tens of millions of seniors have engaged in telehealth visits during the pandemic, many for the first time.

Telehealth utilization by Medicare beneficiaries has increased 63-fold during the pandemic, according to new report from the U.S. Department of Health and Human Services (HHS).

The number of Medicare visits conducted through telehealth climbed from approximately 840,000 in 2019 to 52.7 million in 2020.

“Pre-pandemic telehealth visits for Medicare beneficiaries went from hundreds of thousands to tens of millions, with many utilizing telehealth for the first time,” HHS Acting Assistant Secretary for Planning and Evaluation Rebecca Haffajee said in a press release.

The states where Medicare beneficiaries used Telehealth the most in 2020 were concentrated in New England (Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut). Those with the lowest use of telehealth included Tennessee, Nebraska, Kansas, North Dakota and Wyoming. Black and rural beneficiaries used telehealth less than White and urban beneficiaries, respectively.

Despite the big increase in telehealth visits during the pandemic, total utilization of Medicare fee-for-service Part B clinician visits declined approximately 11% in 2020 compared with 2019, the report also noted.

Broader Accessibility

Telehealth has been accessible to many more seniors during the pandemic, partly because Centers for Medicare & Medicaid Services (CMS) waived geographic restrictions. Prior to the pandemic, Medicare generally only paid for telehealth services in rural areas, although there were exceptions for beneficiaries with end-stage renal disease, stroke and other conditions. Another factor contributing to stepped-up accessibility is that, in response to the pandemic, the HHS Office for Civil Rights relaxed enforcement of HIPAA privacy requirements for videoconferencing.

According to the report, Telehealth increased to 8% of primary care visits and 3% of specialist visits by Medicare beneficiaries in 2020. Most significantly, telehealth accounted for one-third of total Medicare visits to behavioral health specialists in 2020.

Looking Ahead

Telehealth for mental health services is likely to remain an option for many older Americans. CMS recently announced that for the first time outside of the COVID-19 public health emergency, Medicare will pay for mental health visits provided by Rural Health Clinics and Federally Qualified Health Centers via video-based and audio-only telephone calls. CMS is also permanently eliminating geographic barriers and permitting patients in their homes to access telehealth services for diagnosis, evaluation and treatment of mental health disorders. These provisions were part of the Consolidated Appropriations Act of 2021.

CMS clarified that mental health services can include services for treating substance use disorders

Other types of Medicare services added to the telehealth services list  — including some speech/hearing, vision and cardiac services — will be in place through December 31, 2023. CMS is also evaluating whether these services should be permanently added to this list.

Senator Brian Schatz (D-HI), during the recent 2021 Century Summit, addressed the need to make telehealth flexibility more permanent. With the pandemic, “We had a fire under us,” said Schatz, but statutory change is required to retain this flexibility. Congress is working on a bipartisan basis to pass these provisions, he noted. Telehealth, he said, is “a better way to deliver care probably 75% of the time.” The Century Summit is held in December by the Longevity Project in collaboration with the Stanford Center on Longevity.

 

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