Telehealth Use Among Medicare Patients Skyrocketed 63-Fold Last Year

In one year, telehealth usage by Medicare fee-for-service (FFS) beneficiaries increased 63-fold — from approximately 840,000 virtual visits in 2019 to nearly 52.7 million in 2020, according to a new federal report.

Prepared by the Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation, the report analyzes the use of in-person and telehealth visits by Medicare FFS beneficiaries from January to December 2020 and compared it with data from the same period in 2019.

For the study, researchers examined data for 33.08 million Medicare FFS beneficiaries in 2019 and 32.25 million in 2020.

They found that along with the massive spike in telehealth use, there was a concurrent 16.1 percent drop in in-person services.

With the expanded Medicare telehealth flexibilities enacted in 2020, telehealth use by Medicare patients increased to 16.6 million for specialist appointments, a 38-fold increase from 122,400 the previous year. Similarly, telehealth use skyrocketed to 10.1 million for behavioral health specialist appointments, 32-fold jump from 317,800 the year prior; and to 26 million for primary care, 24-fold spike from 400,000 in 2019.

Audio-only telehealth also saw a huge boost in 2020. In the Medicare FFS population, usage of this modality grew from a quarter of all telehealth services in 2019 to one-third in 2020.

In terms of location, the rural-urban divide remained, with the increase in telehealth use last year being driven primarily by urban beneficiaries. Regulatory flexibilities were once again behind this trend.

Overall, urban Medicare beneficiaries used telehealth about 50 percent more than rural beneficiaries — that is, 1,659 visits per 1,000 urban beneficiaries compared to 1,112 visits per 1,000 rural beneficiaries.

These figures represent a 140-fold increase in telehealth use for urban beneficiaries and a 20-fold jump for their rural counterparts as compared with pre-pandemic levels.

Telehealth utilization for Medicare FFS patients also varied by state, another product of differing regulations.

Massachusetts, Vermont, Rhode Island, New Hampshire, and Connecticut experienced the highest levels of telehealth use in 2020, while Tennessee, Nebraska, Kansas, North Dakota, and Wyoming experienced the lowest.

Further, race played a key differentiating factor among Medicare FFS beneficiaries who opted for telehealth, the report shows.

A lower proportion of Black beneficiaries had a visit via telehealth (4.7 percent) compared to white beneficiaries (5.3 percent). On the other hand, a higher share of Hispanics (6.2 percent) and Asians (6.4 percent) had a visit via telehealth compared to white patients.

Similarly, telehealth usage for low-income beneficiaries enrolled in both Medicare and Medicaid was higher compared with beneficiaries enrolled Medicare only — 6.3 percent versus 5 percent.

The final piece of analysis focused on virtual visit use for beneficiaries in alternate payment models (APMs) as compared to those were not. Overall, telehealth use was only slightly higher for beneficiaries in APMs compared to those not in an APM.

But use varied across models. For example, telehealth rates for Medicare beneficiaries in 2020 was 2,042 visits per 1,000 Medicare beneficiaries in Maryland's total cost of care primary care model, as compared with 1,362 telehealth visits per 1,000 Medicare FFS patients not in an APM.

Also, specialty models such as those focused on dually enrolled beneficiaries, those with end-stage renal disease, and who need home care had higher telehealth use per beneficiary in 2020 than the general FFS population.

The rise in telehealth use shows that seniors are ready to use these services. And the Centers for Medicare and Medicaid Services has taken several steps during the COVID-19 pandemic to bolster its use in this population.

For example, CMS is permanently eliminating geographic barriers and allowing patients to access telehealth services for mental health treatment in their homes, including via audio-only telemedicine.

Other Medicare services temporarily added to the telehealth services list during the pandemic will remain in place through Dec. 31, 2023.

"This report provides valuable insights into telehealth usage during the pandemic," said Chiquita Brooks-LaSure, CMS administrator, in a news release. "CMS will use these insights — along with input from people with Medicare and providers across the country — to inform further Medicare telehealth policies."