Telehealth flexibilities haven’t skyrocketed Medicare visits, despite concerns

Older Americans and their healthcare providers have settled into a consistent pattern of using telehealth technology to nearly 1 in 10 outpatient appointments a new analysis of Medicare data shows.

This level of virtual visits persisted throughout the second half of 2021, according to the findings of a team from the University of Michigan. In total, 1 in 3 people with traditional Medicare coverage saw a healthcare provider virtually at least once in 2021.

Meanwhile, in-person visits have declined over the same period and overall since 2019. This runs counter to concerns about a ‘galloping’ increase in total visits after the sudden relaxation of telehealth rules in early 2020 due to the COVID-19 pandemic.

Now that these temporary rules may be coming to an end, the new data could inform the creation of more permanent telehealth policies.

The new rules are needed before the end of the federal public health emergency order that allowed the temporary flexibility. This order was renewed in April and as no notification has been issued that it will be allowed to expire in mid-July, it is likely to be extended for additional months.

That’s why researchers at UM’s Institute for Healthcare Policy and Innovation have chosen to publish their findings now, as a preprint ahead of peer review.

“As the use of telehealth peaks in the Medicare paying population, concerns that flexible telehealth rules could lead to an increase in the total volume of outpatient visits have not dissipated,” said Chad Ellimootil, MD. , MS, lead author of the new preprint and head of the IHPI Telehealth Research Incubator Laboratory. “With all the evidence we have to date, it appears that telehealth has been used as a substitute for in-person care rather than an expansion of care.”

Ellimootil said further analysis is needed to determine whether the lower volume of outpatient services used by Medicare’s fee-for-service population is because older adults are still forgoing routine care.

The new analysis shows that for the second half of 2021, about 9% of all outpatient appointments for people with traditional Medicare coverage took place via video or audio connections. That’s down from telehealth connections made from mid-2020 to mid-2021, but still a massive increase from 2019, when Medicare strictly limited telehealth.

At the same time, the total number of visits and the number performed in person decreased from 2019 to the end of 2021. The authors note that their analysis does not take into account changes in the traditional Medicare population, including those related to COVID- 19. death or transition to Medicare Advantage.

The team previously released a report on the use of telehealth for Medicare assessment and management visits in 2019 and 2020.

Previous and new analyzes show that the use of telehealth was lower among older people living in rural areas. A total of 17% of rural older adults with traditional health insurance had at least one telehealth appointment between 2019 and 2021, compared to 26% of older adults living in non-rural areas. No other major disparities were found.

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