New HHS Report Makes the Case for Continued Telehealth Coverage

Federal efforts to expand Medicare’s telehealth coverage during the early days of the coronavirus pandemic “played a critical role in helping to maintain access to primary care services,” says a new report from the Health and Human Services Department.

The issue brief, released on Tuesday by the Office of the Assistant Secretary for Planning and Evaluation, credits federal officials with creating new opportunities for telehealth at a time when access to in-person care was sharply restricted. According to the report, which analyzes Medicare claims from January through June, the percentage of fee-for-service Medicare services accessed via telehealth jumped from 0.1 percent in February to almost 44 percent in April.

"As soon as we declared COVID-19 a public health emergency, the Trump Administration took bold and rapid action to dramatically expand services that can be provided via telehealth and make it far more convenient for patients and providers," HHS Secretary Alex Azar said in a press release accompanying the 24-page brief. "Today's ASPE report shows that Medicare providers and beneficiaries rapidly embraced these new opportunities. The meteoric rise of telehealth during the pandemic has not only helped us combat the virus, but also prompted a new conversation around the future of patient-centered care."

"The Trump Administration has made expanding telehealth a priority for years, but the pandemic has allowed us to push this revolution in healthcare delivery to new frontiers," added Centers for Medicare & Medicaid Services Administrator Seema Verma, echoing comments she had made two weeks earlier in a Health Affairs blog. "This analysis of CMS utilization data demonstrates the speed and effectiveness with which the healthcare system adapted to that change. Countless clinicians and beneficiaries received important care while avoiding unnecessary exposure to the virus. Now that providers and patients have had a taste, it's difficult to imagine the telehealth genie going back into the bottle."

Along with Verma’s blog, the report offers more evidence that CMS is moving toward permanently expanding telehealth coverage, though when and by how much remain unclear. Officials had hinted that the agency might unveil some or all of the proposed changes this month, but nothing has been found in the Federal register just yet.

Congress, meanwhile, is under pressure to make those changes more expansive through new laws. They’re facing several bills calling to extend coverage or produce detailed studies of how telehealth has been used during the pandemic, along with a task force composed of and supported by hundreds of healthcare providers, companies and telehealth advocates.

According to the study, care providers in rural parts of the country saw a much smaller increase in telehealth visits as a proportion of all primary care visits compared to their counterparts in urban locations. Researchers questioned whether that finding was skewed by the number of patients living in rural areas who used telehealth to connect with providers in urban areas.

Among the 15 most populous areas in the US, meanwhile, Boston saw almost three-quarters of its primary care visits conducted via telehealth in April, while Phoenix occupied the opposite end of the spectrum at about 38 percent.

The report also shrugs off recent speculation that telehealth interest is waning, as the percentage of connected health visits is dropping and more people return to the doctor’s office. Some experts have said this is an expected pendulum swing after such a surge in telehealth use, as providers look to balance virtual and in-person visits to promote sustainability.

“The stable and sustained use of telehealth after in-person primary care visits started to resume in mid-April suggests there may be continued demand for telehealth in Medicare, even after the pandemic ends,” the report said. “The Medicare telehealth and in-person visit trends are supported by outpatient provider trends across payers in recent analyses published by the Commonwealth Fund, showing telehealth helps maintain but does not completely substitute for outpatient in-person visits. Telehealth adoption was widespread and does not appear to be correlated with COVID-19 hospitalizations in major urban areas, but may reflect provider readiness to implement telehealth.”

It also calls for more research on several topics, including the impact of telehealth flexibilities on underserved populations and on provider types and locations, such as federally qualified health centers, rural health centers and the patient’s home. It also suggests more information is needed on the effect that relaxed HIPAA requirements had on telehealth use, and whether broadband availability and the temporary acceptance of new modalities, such as the audio-only phone, play a part on telehealth adoption.

“A key question for future research will be to assess if the Medicare telehealth flexibilities were effective, such as mitigating potential adverse health and cost impacts from COVID-19, including foregone health care,” the report concludes. “Future research could also examine whether telehealth may have improved access to care and health outcomes among underserved beneficiaries.”