Use of telehealth by Medicare fee-for-service (FFS) beneficiaries has grown nearly 13,000% during the COVID-19 pandemic, according to a post on the Health Affairs blog by CMS Administrator Seema Verma last week.
Before the pandemic, about 13,000 Medicare FFS beneficiaries used telehealth each week, according to Verma. By the last week of April, this number had jumped to 1.7 million a week. Between mid-March and mid-June, more than 9 million Medicare FFS beneficiaries used telehealth.
Telehealth usage among Medicare FFS beneficiaries early in the pandemic—between mid-March and mid-June—was fairly evenly spread across demographics. Thirty percent of female beneficiaries and 25% of male beneficiaries used virtual services during this period. Thirty percent of urban beneficiaries and 22% of rural beneficiaries used it. No significant differences in usage were noted between beneficiaries of different races or ethnicities, according to Verma.
After years of incremental growth, telehealth took off in March as the federal government announced physical distancing guidelines and governors and mayors across the country asked or required residents to stay at home to stop the spread of COVID-19. Clinicians and patients turned to telehealth out of necessity.
CMS made the broad provision of telehealth services to Medicare FFS beneficiaries possible in mid-March when it significantly loosened telehealth regulations, temporarily paying clinicians the same rates as an in-person visit to provide various services virtually to Medicare beneficiaries across the country.
According to Verma, CMS added 135 services, including emergency visits and physical therapy services, that can be provided via telehealth to Medicare beneficiaries. CMS is also now allowing Medicare beneficiaries to access care from any location, including their homes, even if located in an urban setting. It is notable that 30% of urban Medicare FFS beneficiaries used telehealth during the pandemic, since they previously could not use telehealth services even under limited circumstances.
Previously, Medicare paid for certain telehealth services only under limited circumstances. For example, the service had to be conducted in real time via interactive audio and video, and the beneficiary had to be present in a medical facility in a designated rural area for the virtual visit.
Medicare beneficiaries are open to using telehealth in place of in-person visits in the future. In a survey of 10,000 US consumers conducted by HRI in April, 45% of consumers with Medicare (including Medicare FFS and Medicare Advantage) said they would consider using telehealth for initial assessment of a physical condition or ailment in place of an in-person visit in the future. Forty-seven percent would consider it for ongoing treatment of a physical condition or ailment, 33% for emergency situations and 20% for mental health services.
Verma said CMS is evaluating whether to make the recent regulatory changes around telehealth permanent. As part of that evaluation, CMS will consider ongoing assessment of clinical appropriateness and safety, reimbursement rates and the potential for fraud.
Legislators also are looking to make the increased access to telehealth for Medicare beneficiaries permanent. Rep. Mike Thompson, D-Calif., along with members of the House telehealth caucus, recently introduced a bill that would expand Medicare telehealth sites to include federally qualified health centers, expand telehealth beyond designated rural areas and allow telehealth to continue to be delivered in the home.