Medicare’s Telehealth Experiment Could Be Here to Stay | Smart Change: Personal Finance

The policy changes were supposed to be temporary, but data on telehealth use is being analyzed to help policymakers decide the future of these services under Medicare.

The HHS report “provides valuable insight into the use of telehealth during the pandemic,” said Chiquita Brooks-LaSure, who heads the Centers for Medicare & Medicaid Services, in a press release. “CMS will use this information – along with contributions from people on Medicare and providers across the country – to inform Medicare telehealth policies. “

Prior to 2020, Original Medicare only covered telehealth under fairly limited circumstances (private insurers offering Medicare Advantage plans have much more leeway to set their own telehealth policies).

Since the start of the COVID-19 pandemic, telehealth services under Medicare have been made more flexible in several ways.

• Before: Only rural beneficiaries were eligible (with the exception of a few special circumstances).
• During the pandemic: Both urban and rural beneficiaries are eligible.
• Before: The services were to be provided in a health facility.
• During the pandemic: Patients can receive telehealth services at home or at a health facility.

In addition, only a limited number of telehealth services were available before 2020; during the pandemic, 140 eligible services were added.

Medicare telehealth use skyrocketed in 2020, but the magnitude of the change differs significantly in terms of provider types, geography, and patient demographics. Telehealth primarily applies to care treated under Medicare Part B, which covers physician visits and other outpatient medical services.

In 2019, Part B beneficiaries had approximately 840,000 telehealth visits (approximately 1 visit per 40 beneficiaries). In 2020, this number increased to 52.7 million telehealth visits (approximately 1.6 visits for each beneficiary).

The trends were very different for health care in general. Initial Medicare beneficiaries had 16.1% fewer in-person care visits in 2020 compared to 2019.

In total, the vast majority of Part B care – over 93% – was still provided in person. As a result, the increase in telehealth does not account for the full decline in in-person visits caused by the pandemic. Overall, there were about 11% fewer total visits of all types on Medicare Part B in 2020 compared to 2019.

About 38% of behavioral health visits in 2020 were telehealth visits – more than quadruple the rate for primary care (8.3%) and almost 15 times the rate for specialty care (2.6%).

The report notes two major factors that may be contributing to the growth of telehealth for behavioral health services:

• “Stress, loneliness, unemployment and economic uncertainty during the pandemic” could stimulate the growth of mental health-related diagnoses and behavioral health services.
• Behavioral health care providers such as psychologists, psychiatrists and social workers were “well suited to [provide] telehealth, as physical exams or face-to-face diagnostic tests may be required less frequently. “

Before the pandemic, Medicare beneficiaries in rural areas could receive telehealth services, but others could only use telehealth if they had certain medical conditions. Many beneficiaries accessed telehealth services through Medicare for the first time during the pandemic, and those outside of rural areas immediately began using telehealth at higher rates than people in rural areas.

The report cites differences in broadband Internet access, pre-existing state telehealth policies, and providers’ willingness to provide telehealth services as drivers of the rural-urban difference.

The report states that “all groups experienced a similar overall decline in health services in 2020,” but black beneficiaries, in particular, received the fewest telehealth services.

White recipients used telehealth at rates equal to the overall average, and Hispanic and Native American / Alaska Native recipients used telehealth at higher rates. Asian American beneficiaries had the greatest difference between urban and rural telehealth use:

As with the urban-rural divide, the report notes that access to technology could be at the root of racial disparities. In particular, the report underlines “the need for policy makers to address the digital divide by increasing broadband access and supporting the access and ease of individuals to use internet technology and integrate telehealth into services. interpreters “.

The federal government has extended telehealth as part of Medicare as a temporary measure in response to the COVID-19 pandemic. The Centers for Medicare & Medicaid Services have taken administrative steps to extend telehealth flexibility until 2023, but Congress is expected to pass new legislation to make some of the changes permanent.

Because the overall effects of the COVID-19 pandemic on the health care system have been so pervasive, it is difficult to draw telehealth-specific conclusions as a guide for making decisions.

Citing this difficulty, the HHS report concludes that its findings “underscore the need to carefully consider the extension of Medicare telehealth flexibilities after the pandemic ends and to assess the impacts of telehealth on patient access. , the quality of health care and health outcomes ”.

Likewise, the non-partisan Medicare Payment Advisory Commission recommended to Congress that many of the telehealth reforms in the pandemic era continue at least long enough to study their effects. A group of more than 400 healthcare-related organizations also signed a July 2021 letter urging Congress to make Medicare telehealth reforms permanent.

A number of bipartisan bills currently in committee in Congress would extend various Medicare telehealth reforms, but it’s not clear whether any of them are likely to pass.

You can request telehealth appointments from your health care providers in person, over the phone, or using a patient portal like MyChart. Depending on your health care needs, there may be several options for receiving care without leaving your home:

• Substitute for an in-person visit. A Medicare telehealth visit allows you to communicate with health care providers in real time by phone or video chat. Typically, you can only have a Medicare telehealth visit with a provider you’ve seen in person. During the public health emergency, however, new patients are allowed to have telehealth visits even if they have never seen the provider before.
• Check if you need an appointment. A virtual recording allows you to briefly communicate with healthcare providers to decide if an in-person visit is necessary. You can either connect in real time by phone or video chat, or send a message with all relevant audio or video attachments to your healthcare provider. Providers can respond by phone, audio or video recordings, secure text messages, email, or messages on your patient portal. Virtual recordings are only available for established patients.
• Ask a quick question. An electronic visit allows you to send a secure message similar to an email to healthcare providers through your patient portal. If you have a quick, non-urgent question, it may be easier to send a message rather than waiting on the phone for a provider to be available. Electronic visits are only available to established patients.

The article Medicare Telehealth Experiment Might Be Here to Stay originally appeared on NerdWallet.