While analyzing Medicare data from 2021, researchers from the University of Michigan's Institute for Healthcare Policy found that telehealth use remained steady, serving as a substitute for in-person care for Medicare beneficiaries and avoiding a spike in visits and costs.
Due to the COVID-19 pandemic, telehealth became widespread, spurred by various regulatory flexibilities enacted by federal and state agencies. For the study, researchers examined Part B claims for Medicare fee-for-service beneficiaries. They included all outpatient evaluation and management services received by beneficiaries from Jan. 1, 2019, to Dec. 31, 2021, and calculated the monthly proportion of services that were conducted in-person and through telehealth.
Overall, the total number of outpatient E&M services was 289 million in 2019, 255.2 million in 2020, and 260.7 million in 2021.
Telehealth visits rose to a peak of 7.2 million in 2020 (representing about 50 percent of monthly visits for E&M services) before declining slowly through 2021. But they remained high compared to pre-pandemic levels.
In 2021, about one in three Medicare beneficiaries met with a provider virtually at least once. In the second half of 2021, 9 percent of monthly Medicare appointments occurred virtually. At the same time, in-person care decreased.
The total volume of outpatient E&M services was lower in 2020 and 2021, "suggesting that the COVID-19 telehealth flexibilities have not increased the overall volume of outpatient E&M services received by Medicare beneficiaries," researchers concluded.
The withdrawal of many regulatory restrictions on telehealth during the COVID-19 pandemic led to concerns about a rise in healthcare utilization and costs. However, Medicare beneficiaries maintained a steady level of telehealth use.
“As telehealth use hits its stride in the Medicare fee-for-service population, the fears that flexible telehealth rules might lead to an increase in the total volume of outpatient visits has not panned out,” said Chad Ellimoottil, MD, lead author of the new preprint and leader of IHPI’s Telehealth Research Incubator lab, in a press release. “With all the evidence we have to date, it appears that telehealth has been used as a substitute for in-person care rather than an expansion of care.”
Although the future expansion of telehealth flexibilities is likely, it is not yet certain. The federal public health emergency order, to which the flexibilities are tied, was renewed in April and will expire in mid-July. But researchers surmise that the popularity of telehealth and the fact that it does not increase overall costs may lead to an extension of the flexibilities.
However, before taking new steps, disparities must be dealt with. The most prominent for researchers was the lower telehealth use rate among rural residents. Data showed that 17 percent of older adults with Medicare coverage in rural areas participated in a telehealth visit from 2019 to 2021, lower than the 26 percent of older adults living in non-rural areas.
Throughout the COVID-19 pandemic, lawmakers have made various efforts to increase telehealth services provided under the Medicare program.
In March, Congress passed the omnibus spending bill, which included several provisions to extend telehealth flexibilities for Medicare patients for at least five months after the public health emergency officially expires.
Further, in August 2021, a Montana congressman sought to improve rural healthcare access by introducing a bill that would allow for Medicare coverage of asynchronous telehealth in 50 states.