Patients in most disadvantaged areas used telehealth in pandemic: study

Some healthcare leaders have worried about disparities in use of telemedicine. The new study shows many in impoverished communities turned to telehealth.

Telemedicine helped all Medicare populations, including some living in the most disadvantaged communities, get access to healthcare, according to a new study in Health Affairs.

While there has been growing concerns about some members of minority groups and seniors not enjoying as much access to virtual care, the study suggests telemedicine is being utilized by underserved populations.

In fact, the study found the highest usage of telemedicine among Medicare recipients came from those in the most disadvantaged neighborhoods. Researchers at Johns Hopkins University and Brigham and Women’s Hospital conducted the study, which was published Monday afternoon.

“Overall, these findings are encouraging, but they illuminate a need for targeted interventions to improve telemedicine access further,” the authors wrote. (The story continues after the video.)

Telemedicine usage soared during the COVID-19 pandemic, particularly in 2020. The federal government eased restrictions that had limited access to telehealth, and for some, the only way they could see a provider was via a virtual appointment. Telemedicine use skyrocketed 63-fold among Medicare recipients in 2020, according to a federal report. Medicare reported 52.7 million telehealth visits in 2020, up from 840,000 the previous year.

Researchers in the Health Affairs study found substantial increases in telehealth use among Medicare beneficiaries of all groups. While those in the most disadvantaged communities weren’t actively using telehealth before the arrival of COVID-19 and the lifting of the federal waivers, those living in disadvantaged neighborhoods utilized telemedicine services after the pandemic emerged.

The authors acknowledged they were surprised to find that those in the most disadvantaged areas had the greatest increase in the use of telehealth, since previous studies have shown links between socioeconomic status and usage.

The authors noted they used the Area Deprivation Index, a composite including income, employment, housing and education, in evaluating access in disadvantaged areas.

In addition, the authors said they used national Medicare claims data to assess trends in Medicare use during the pandemic.

“​​Overall, our data suggest large swings in access to telemedicine across the United States for all populations, including people living in the most disadvantaged neigh- borhoods,” the authors wrote.

All minority populations had greater use of telemedicine after the government eased restrictions. “Thus, our data suggest that the increase in telemedicine coverage has not worsened racial disparities in the Medicare population in the way some investigators feared,” the authors wrote.

Before the federal waivers took effect, telehealth usage was largely restricted to rural areas for those who didn’t have easy access to a doctor. With the government easing those rules, many in cities that hadn’t been able to utilize telemedicine took advantage of the opportunity, the authors wrote.

The authors noted telemedicine usage dropped after peaking early in the pandemic, but they found it encouraging that those in the most deprived communities still continued to have the highest usage of telemedicine.

Before the government eased rules on telemedicine, 0.42% of Medicare recipients used telehealth at least once. After restrictions were eased, nearly 10% of Medicare beneficiaries had at least one outpatient telemedicine visit.

Telemedicine usage dropped among older Medicare recipients, with rates being lowest for those 85 and older. Since older patients are less likely to have or adopt new technology, age remains a significant barrier in access to telehealth, the authors said.

The authors said it’s critical to continue research to ensure all populations can utilize telehealth, during and beyond the pandemic.

Still, concerns persist about access to telehealth. A federal report released earlier this year showed disparities in usage of telehealth, particularly in video services. Black, Latino and Asian Americans were less likely to use video services than white patients, the study found. Health leaders say that’s a concern, since many doctors say video visits are superior.

Many healthcare advocates are pressing Washington to allow continued access to telehealth beyond the pandemic. They want to be able to continue to prescribe medicine and offer behavioral health medicine in virtual visits. The waivers are tied to the government’s declaration of a public health emergency for COVID-19. The emergency has been extended until mid-July.

As part of the 2022 budget, President Biden’s administration and Congress agreed to allow continued access for telehealth five months after the public health emergency ends. Health advocates are urging Congress and the White House for permanent reforms.