telehealth visit on laptop between doctor and patient

Medicare Telehealth Usage Expands During the Pandemic

Virtual Visits Show 63-fold Increase in One Year

For many people, telehealth during the pandemic became a way to receive needed healthcare without risking exposure to SARS-CoV-2, the coronavirus that causes COVID-19.

The Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation released a research report “Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location.” The Office of Health Policy document indicated Medicare fee-for-service beneficiaries made nearly 52.7 million telehealth visits in 2020, a 63-fold increase from about 840,000 telehealth visits in 2019. Telehealth visits represented 5 percent of Medicare fee-for-service clinician visits.

The study included Medicare Part B billing data for 34.9 million fee-for-service beneficiaries, who had made in-person and telehealth visits.

While telehealth usage during the COVID pandemic increased, Medicare fee-for-service beneficiaries made 11.4 percent fewer clinician visits overall in 2020 as compared to 2019. In-person primary care visits dropped significantly in early 2020, which was partially offset with the virtual visits.

Increasing Access to Telehealth

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, enacted in March 2020 in response to the pandemic, temporarily waived many of Medicare’s prior telehealth requirements, such as making the technology available only in rural areas, at a healthcare facility. It also allows visits via audio as well as video, which had been a requirement.

Once those limitations were lifted, 92 percent of beneficiaries received telehealth visits in their homes.

Behavioral health specialists saw the greatest increase in telehealth visits; more than a third of all behavioral health visits, 38.1 percent, were made virtually in 2020, a 32-fold increase from 2019. Telehealth visits peaked at 280,000 weekly in May 2020 and declined to about 250,000 per week at the end of 2020. In-person behavioral health visits were down 43.8 percent. Total mental health visits, in-person and telehealth, declined 10.2 percent.

Specialty care. Telehealth usage during COVID increased the most for specialty care, 38 times as many virtual visits than in 2019. Telehealth visits peaked at 669,000 weekly. While specialty televisits grew, they only represented 2.6 percent of all specialty visits. In-person specialty care visits were down 14.5 percent, and overall, in-person and telehealth specialty visits were off 12.2 percent, the largest decrease in utilization. 

Primary care telehealth during the pandemic increased 24 fold from 2019. The proportion of total primary care visits conducted through telehealth was 8.3 percent. A weekly peak in primary care telehealth visits was 1 million in April 2020 and then declined to about 440,000 in September 2020 and up to 626,000 in December 2020. In person visits for primary care dropped 17.2 percent. A combination of in-person and telehealth visits were down 9.8 percent for primary care.

Variations by Location, Race and Ethnicity

The HHS report found Black and rural beneficiaries did not use telehealth as much as White and urban beneficiaries. People in the Northeast and West used telehealth the most, and usage was lowest in the Midwest and South.

Before the pandemic, Medicare limited telehealth to rural beneficiaries, except for people with end stage renal disease, stroke or certain other conditions. CMS waived the rural requirement during the pandemic. Most of the increases in telehealth visits occurred with urban beneficiaries, whose use of the virtual visits was 50 percent higher than rural beneficiaries. In April 2020, 65 per 1,000 urban beneficiaries used telehealth services as compared to 46 per 1,000 rural beneficiaries. By November, that had decreased to 32 per 1,000 for urban residents and 21 per 1,000 rural patients.

The use of Federally Qualified Health Clinics and Rural Health Clinics serving as distant site telehealth providers increased from 9,000 telehealth visits in 2019 to more than 830,000 in 2020, a 100-fold jump.

Rates of telehealth use also varied by state. Beneficiaries in Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut had the highest usage in 2020, and Tennessee, Nebraska, Kansas, North Dakota and Wyoming the lowest. The authors suggest that state and local policies and access to broadband and technology could be responsible for the state variations.

Black beneficiaries used telehealth less frequently than White beneficiaries. Hispanic and Asian beneficiaries used telehealth the most. All racial and ethnic groups made fewer healthcare visits, a combination of in-person and telehealth, in 2020 than 2019. Dual eligible beneficiaries, enrolled in both Medicare and Medicaid, also experienced a decline in healthcare utilization in 2020.

Telehealth use was slightly higher for Medicare beneficiaries participating in alternative payment models, except for those in “all-payer, total cost of care state-based models.”  

The authors concluded that more research is needed to determine how telehealth usage has affected outcomes and costs.

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