Audio-only telehealth use on the decline among Medicare patients

Audio-only telehealth visits declined from 31 percent of all telehealth visits in 2020 to 25.4 percent in 2022, according to new research published in JAMA Health Forum.

Researchers from Weill Cornell Medicine in New York City conducted the study, assessing changes in audio-only telehealth use over time and determining which patients would most be affected by policy reforms.

During the COVID-19 pandemic in-person care restrictions, the Centers for Medicare and Medicaid Services (CMS) expanded telehealth coverage, including audio-only telehealth. However, these regulatory flexibilities are due to expire at the end of the year. While telehealth proponents emphasize how expanded audio-only telehealth coverage has expanded access to care for those experiencing digital divide challenges, opponents state that audio-only visits may lead to poorer quality care and increased costs, the study notes.

The researchers conducted a cross-sectional study to evaluate telehealth visits as a proportion of all evaluation and management (E&M) visits and audio-only visits as a proportion of all telehealth visits. They used 100 percent Medicare fee-for-service carrier file claims from 2020 to 2022 to examine E&M visits. They also obtained data on patient characteristics, including age, sex, race and ethnicity, rurality, and dual eligibility for Medicare and Medicaid, from the Medicare Beneficiary Summary File.

Of 34.72 million Medicare beneficiaries included in the study, 15.46 million (44.5 percent) were female, and 19.26 million (55.5 percent) were male, with an average age of 72.

From 2020 to 2022, telehealth visits as a proportion of all Medicare E&M visits decreased from 16.1 percent to 7.8 percent. During the same period, audio-only visits as a proportion of all telehealth visits decreased from 31 percent to 25.4 percent.

In 2022, most Medicare beneficiaries (72.5 percent) received only in-person care. Compared to the in-person care group, those who received at least one audio-only visit were more likely to be dually eligible and have medically complex conditions. They were also more likely to be female, Black, and Hispanic and less likely to reside in rural areas.

Further, researchers observed that Medicare beneficiaries who received one or more audio-only telehealth were more likely to be dually eligible, have medically complex conditions, be Black and older, and reside in rural areas compared with the 17.5 percent of beneficiaries who received video-based telehealth visits.

The researchers hypothesized that the decrease in audio-only telehealth use “may be partly due to uncertainty about continued payment for audio-only visits or about the quality and patient satisfaction associated with audio-only care.”

Still, audio-only telehealth is primarily used by people from minority groups and underserved populations. The researchers noted that restricting these services could “disproportionately affect these beneficiaries.”

Previous research also highlights how audio-only telehealth bolsters access to care for vulnerable groups.

A study published in April 2023 revealed that audio-only telehealth was more popular than video visits in safety net clinics in California. RAND Corp. researchers gathered information regarding telehealth usage between February 2019 and August 2022 at 30 multisite federally qualified health centers (FQHCs). These facilities care for 1.3 million lower-income people yearly.

They found that audio-only telehealth use for primary care in the FQHCs skyrocketed to 67 percent in April 2020 before dropping to 21 percent in August 2022. In contrast, video visits rose from 4 percent in April 2020 to 7 percent in August 2022.

Though extended coverage of audio-only telehealth under the Medicare program is slated to expire at the end of 2024, the United States House of Representatives may extend the flexibility by an additional two years.

Last week, the US House Ways and Means Committee advanced the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend audio-only telehealth coverage through December 31, 2026. The bill will now move to the House floor for a vote.