Research out of Johns Hopkins University shows that expanded access to telehealth during the coronavirus pandemic brought significant benefit to historically underserved communities with minority populations and in metropolitan areas. The study, published in Health Affairs, examined about 30 million Medicare claims that were made from 2019 to 2021, with researchers comparing telehealth use before and after March 2020 when the Centers for Medicare & Medicaid Services (CMS) instituted a waiver to broaden Medicare-covered telehealth services.
Under the waiver, Medicare pays for tele-visits with doctors, nurses, psychologists, social workers, and other healthcare professionals who serve patients all across the country. And healthcare providers are given greater latitude to waive or reduce cost-sharing for telehealth services provided through federally funded healthcare programs. Prior to this waiver, Medicare coverage of telehealth services was limited to specific facilities and to patients who live in designated rural areas. Expanding these services into cosmopolitan areas during the COVID-19 lockdowns of 2020 offered a unique window into telehealth use and its impact on urban communities.
According to the study, only 0.42% of patients had at least one outpatient telehealth visit prior to the March 2020 waiver. This percentage was consistent across varying socioeconomic groups, though patients in rural areas were four times more likely to use Medicare-covered telehealth services. After the waiver, however, the share of patients with at least one tele-visit rose to nearly 10% and the demographics shifted; people in disadvantaged areas were more likely to use telehealth services, while Hispanics, Asians, and women used these services more than other subgroups. However, not every underserved group saw the same benefits. According to a report by The Assistant Secretary for Planning and Evaluation (ASPE), which advises the Department of Health and Human Services, Black beneficiaries had lower telehealth use than their white counterparts in 2020.
Data from the CMS Medicare Telemedicine Snapshot found that between March 2020 and February 2021, the percentage of Medicare users with telemedicine service was 44% in rural areas of America and 55% in urban areas. ASPE data shows that in 2020, telehealth use was higher in Northeastern and Western states and lower in Midwestern and Southern States. As for the quality of this expanded telehealth care? That’s yet to be studied. The U.S. Government Accountability Office (GAO) said in a recent GAO report, “Medicaid hasn’t collected or assessed data on the quality of care beneficiaries received from telehealth services. We recommended doing so… given concerns GAO has raised about the quality of care provided via telehealth.”