Medicare telehealth use increased 63-fold due to COVID-19 pandemic

Medicare reported 52.7 million telehealth visits in 2020, up from 840,000 in the previous year. But virtual visits varied among states and different groups of patients.

Medicare beneficiaries utilized telehealth far more than ever before due to the COVID-19 pandemic, but a new report sheds new light on the staggering growth of virtual visits.

There were 52.7 million telehealth visits by Medicare beneficiaries in 2020, compared to 840,000 in 2019, according to the report from the U.S. Department of Health and Human Services. That represents a 63-fold increase over the previous year.

The federal government relaxed policies to make telehealth more accessible when COVID-19 spread nationwide. Most beneficiaries (92%) used telehealth services at home, which wasn't allowed by Medicare before the pandemic.

The report, which was released Dec. 3, found noteworthy differences in the use of telehealth visits around the country.

Black Medicare beneficiaries and residents in rural areas were least likely to take advantage of telehealth services. States in the northeast were most likely to utilize telehealth services, the report found.

Even with the greater use of telehealth services, fewer beneficiaries had contact with a doctor in 2020. Clinician visits fell 11% in 2020 compared to the previous year.

New England states showed the highest usage of telehealth: Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut. As the report noted, the COVID-19 spread rapidly in the northeast at the beginning of the pandemic, which may have spurred more patients to consider telehealth services for the first time.

In 2020, these states had the lowest use of telehealth services: Tennessee, Nebraska, Kansas, North Dakota and Wyoming.

The report noted many Medicare beneficiaries used telehealth to gain access to behavioral health services, which showed the biggest increase of telehealth services. Telehealth accounted for more than a third of all behavioral healthcare visits from Medicare beneficiaries in 2020.

Telehealth visits rose dramatically among primary care visits - a 24-fold increase. Still, telehealth accounted for 8.3% of primary care visits.

Among Black patients, telehealth visits accounted for 4.7% of their total healthcare visits. White beneficiaries had a higher usage of telehealth visits: 5.3% of all visits.

However, Asian and Hispanic beneficiaries were both more likely to use telehealth than white patients, the report found. Among Asian patients, telehealth represented 6.4% of all visits, just ahead of Hispanic beneficiaries (6.2%). Among American Indian and Alaska Native beneficiaries, teleheatlh accounted for 5.6% of visits, which was also higher than white patients.

Residents in rural areas were less likely to use telehealth (4.3% of all visits) compared to urban residents (5.7%). The report noted this could be at least in part due to challenges with internet access in rural areas.

Last month, the Center for Medicare and Medicaid Services said it would pay for mental health services outside of the COVID-19 pandemic.

In November, CMS said it will cover mental health visits by Rural Health Clinics and Federally Qualified Health Centers via telehealth, including audio-only telephone calls. CMS also said it is permanently eliminating geographic barriers and will allow patients to use telehealth for mental health services.

The report noted more research is needed to understand how the use of telehealth is affecting health outcomes. If telehealth services are extended beyond the pandemic, it would allow researchers to understand if telehealth is offering greater access to healthcare services or is merely a substitute for in-person visits.

The data also "raises important questions about how to prevent telehealth from exacerbating existing disparities by race/ethnicity and rurality," the report's authors concluded.

CMS Administrator Chiquita Brooks-LaSure said the report offered important insights on the use of telehealth in the pandemic.

"CMS will use these insights – along with input from people with Medicare and providers across the country – to inform further Medicare telehealth policies," she said in a statement.

The Business Group on Health said virtual healthcare would remain one of the top health trends in 2022.

The organization, which represents large employers, said virtual visits would need to be integrated with in-patient care. Patients will need help navigating virtual and in-person options for care, the group said.