Telehealth Waiver Boosted Care Access for Medicare Beneficiaries

The CMS telehealth waiver that expanded coverage for virtual care services during the COVID-19 pandemic helped increase access to virtual care for Medicare beneficiaries in disadvantaged neighborhoods, a Health Affairs study found.

Before the pandemic, Medicare reimbursement for telehealth services was restricted to rural areas and certain medical facilities. However, CMS and HHS waived geographic restrictions and allowed all providers to bill Medicare for telehealth visits at the same rate as in-person visits.

To determine how this expanded coverage impacted Medicare beneficiaries in disadvantaged neighborhoods, researchers gathered Medicare fee-for-service claims for individuals with at least one outpatient visit between January 1, 2019, and March 31, 2021. The researchers used the Area Deprivation Index (ADI) to determine the geographic socioeconomic disadvantage in neighborhoods.

Before CMS implemented the telemedicine coverage waiver, the telemedicine utilization rate was relatively stable across each ADI quartile, the study found. Nearly 30.5 million Medicare beneficiaries had at least one outpatient visit claim before the waiver, with almost 130,000 of these beneficiaries (0.42 percent) having at least one telemedicine visit.

After telemedicine coverage was expanded, utilization increased across all ADI quartiles. Following the waiver, 28 million beneficiaries had at least one outpatient visit claim, with more than 2.7 million participating in a visit via telemedicine (9.97 percent).

Beneficiaries living in the least disadvantaged neighborhoods saw a 56-fold increase in telemedicine utilization, while individuals in the most deprived communities experienced a 28.9-fold increase.

During the first week post-waiver, individuals in the least disadvantaged neighborhoods saw the largest increase in telemedicine use. But those in the most disadvantaged areas were most likely to use telemedicine throughout the entire post-waiver period, the researchers found.

Before the waiver, after adjusting for demographic variables, comorbidities, and region and residency factors, beneficiaries in the most disadvantaged neighborhoods had similar odds of using telemedicine compared with their counterparts in the least disadvantaged neighborhoods.

In contrast, beneficiaries in disadvantaged neighborhoods were more likely to use telemedicine after the waiver was implemented than those in less disadvantaged communities.

“The correlation shown by our data suggests that CMS was, in fact, successful in reaching even people in the most disadvantaged US neighborhoods with its telemedicine coverage waiver, at least among Medicare beneficiaries,” the study stated

Despite past studies highlighting concerns about telemedicine exacerbating racial disparities, this data suggests the opposite. Telemedicine coverage expansion helped increase access to virtual care for minority populations compared to White beneficiaries, the researchers found.

Following the coverage waiver, the odds of accessing telemedicine services changed for beneficiaries in rural areas.

Since telemedicine coverage was restricted to rural areas before the pandemic, living in rural locations was unsurprisingly associated with higher odds of telehealth use. For example, individuals in rural areas were more than four times more likely to use telemedicine than those living in metropolitan areas.

However, once the waiver eliminated geographic restrictions, beneficiaries in rural areas had 22 percent lower odds of using telemedicine than beneficiaries in metropolitan areas. This suggests that the waiver helped increase access to virtual care for individuals who were previously ineligible for telemedicine coverage.

Telemedicine utilization among older beneficiaries continued to decrease after CMS implemented the coverage waiver. This population tends to have lower digital literacy and limited access to technology compared to their younger counterparts.

Overall, the telemedicine flexibilities helped boost access to virtual care for Medicare beneficiaries during the COVID-19 pandemic. Data from August 2020 revealed that the coverage waivers also helped increase telehealth access for Medicare Advantage beneficiaries.

However, the expiration of these waivers is tied to the end of the public health emergency (PHE). Industry leaders have called on policymakers to make the telehealth benefits permanent to ensure Medicare beneficiaries maintain access to virtual care after the PHE ends.