Today, the U.S. Department of Health and Human Services, through the Assistant Secretary for Planning and Evaluation, is releasing a new report showing the dramatic utilization trends of telehealth services for primary care delivery in Fee-for-Service (FFS) Medicare in the early days of the coronavirus disease 2019 (COVID-19) pandemic. The report analyzes claims data from January through early June. The report underscores how telehealth flexibilities, introduced by the Trump Administration to address the care delivery disruptions caused by the pandemic, helped to spur and maintain Medicare beneficiaries' access to their primary care providers.
"As soon as we declared COVID-19 a public health emergency, the Trump Administration took bold and rapid action to dramatically expand services that can be provided via telehealth and make it far more convenient for patients and providers," said HHS Secretary Alex M. Azar. "Today's ASPE report shows that Medicare providers and beneficiaries rapidly embraced these new opportunities. The meteoric rise of telehealth during the pandemic has not only helped us combat the virus, but also prompted a new conversation around the future of patient-centered care."
At the start of the COVID-19 public health emergency (PHE), with stay-at-home orders in place and warnings on the risk for severe illness from COVID-19 increasing with age, the report found Medicare FFS in-person visits for primary care fell precipitously in mid-March. It then found that in April, nearly half (43.5%) of Medicare primary care visits were provided through telehealth compared with less than one percent (0.1%) in February before the PHE.
"The Trump Administration has made expanding telehealth a priority for years, but the pandemic has allowed us to push this revolution in healthcare delivery to new frontiers," said CMS Administrator Seema Verma. "This analysis of CMS utilization data demonstrates the speed and effectiveness with which the healthcare system adapted to that change. Countless clinicians and beneficiaries received important care while avoiding unnecessary exposure to the virus. Now that providers and patients have had a taste, it's difficult to imagine the telehealth genie going back into the bottle."
The spike in telehealth visits as a care option is the direct result of actions taken by the Trump Administration. First, with the emergency declarations made by the President and Secretary, the Centers for Medicare and Medicaid Services (CMS) was able to use waiver authority under section 1135 of the Social Security Act to lift geographic and site of service restrictions to allow telehealth services to be delivered wherever a beneficiary is located, including their home or temporary health care sites. CMS then used emergency rulemaking to add 135 services to the Medicare telehealth services list, and further waiver authority to expand the types of practitioners who can provide telehealth services. Internal CMS analysis has found that before the PHE, only 14,000 beneficiaries received a telehealth service in a week but during the PHE period from mid-March through early-July, over 10.1 million beneficiaries have received a telehealth service.
Second, the HHS Office for Civil Rights announced it is exercising its enforcement discretion and will not impose Health Insurance Portability and Accountability Act (HIPAA) penalties on covered health care providers for HIPAA violations in connection with the good faith delivery of telehealth using non-public facing technologies.
The combined result was a game-changer in Medicare FFS. The report finds telehealth adoption increased by nearly 50 percent in primary care at the peak and further dissects weekly utilization rates from January through early June 2020. While the report did not analyze specialist visits, other studies mentioned in the report have also shown dramatic increases in telehealth use during the pandemic among specialists such as psychiatry, gastroenterology and neurology to name a few.
Rural vs Urban Telehealth Utilization
Providers in both rural and urban counties saw increases in telehealth adoption and utilization, however, providers in rural counties saw a smaller growth in telehealth visits as a proportion of all primary care visits in March and April, with a decrease again in May. By contrast, providers in urban counties, saw greater telehealth use in March and April and smaller declines in May. Massachusetts, Rhode Island, Connecticut, and New York saw the highest uptake in telehealth primary care visits at the beginning of the PHE. Iowa, South Dakota and Oklahoma, more rural states, experienced a one-third increase of primary care visits by telehealth in April. Even the state with the lowest telehealth adoption, Nebraska, saw an increase in telehealth, up to 22 percent of primary care visits.
Urban areas with high rates of COVID-19 - New York City, Boston, Phoenix and Seattle - saw high but wide-ranging uptake in telehealth primary care visits at the beginning of the PHE, ranging from one third of primary care visits in Phoenix to nearly two-thirds in Boston.
Interest for Telehealth Post-Pandemic
The report also provided insights into the transformative and lasting ways telehealth will continue to supplement care delivery. Even after Medicare in-person primary care visits resumed in May, there continues to be steady demand for telehealth visits which are now more broadly available to Medicare beneficiaries and providers during the PHE. This suggests there will be continued interest in telehealth post-pandemic for millions of Medicare beneficiaries. Recent surveys of practitioners also suggest continued interest in telehealth among health care providers. For example, in a survey of about 300 practitioners (oncologists, specialists, and primary care) by IQVIA between April 17 and 22, 2020, practitioners said only 9 percent of their patient interaction was via telehealth prior to the pandemic; but that increased to 51 percent during the pandemic period, and they expected it to remain at 21 percent after the pandemic ends. While in-person patient-provider interactions will remain necessary and preferred, this pandemic has accelerated openness to telehealth in ways previously unseen – from policymakers to providers and patients alike.