key: cord-0900588-yvlfg9ye authors: Hamadi, Hanadi Y.; Zhao, Mei; Haley, Donald Rob; Dunn, Ajani; Paryani, Shyam; Spaulding, Aaron title: Medicare and telehealth: The impact of COVID‐19 pandemic date: 2021-11-16 journal: J Eval Clin Pract DOI: 10.1111/jep.13634 sha: 153001e047e76d8c8f40a3aa73cba31ac85d2078 doc_id: 900588 cord_uid: yvlfg9ye STUDY RATIONALE: The swift progression of the COVID‐19 pandemic appeared to facilitate the increase in telehealth utilization. However, it is clear neither how telehealth was offered by providers nor how it was used by patients during this time of unusual and rapid change within the health industry. AIM: To investigates the telehealth utilization patterns of Medicare beneficiaries during the height of the COVID‐19 pandemic. METHODS AND MATERIALS: A cross‐sectional study design was used to examine the responses of 9686 Medicare beneficiaries to the Centers for Medicare and Medicaid Services (CMS) Medicare Current Beneficiary Survey, Fall 2020 COVID‐19 Supplement. Multiple logistic regression analyses were conducted to examine the relationship between telehealth offering and beneficiaries' sociodemographic variables. RESULTS: Over half (58%) of primary care providers provided telehealth services, while only 26%–28% of specialists did. Less than 8% of Medicare beneficiaries reported that they were unable to obtain care because of COVID‐19. CONCLUSIONS: This research found that changes in Medicare policy, associated with CMS' declaration of telehealth waivers during the Public Health Emergency (PHE), likely increased the proliferation and utilization of telehealth services during the COVID‐19 pandemic, providing important access to care for certain populations. With the impending conclusion of the PHE, policymakers must 1) ascertain which elements of the new telehealth landscape will be retained, 2) modernize the regulatory, accreditation and reimbursement framework to maintain pace with care model innovation and 3) address disparities in access to broadband connectivity with a particular focus on rural and underserved communities. (at the peak of the pandemic) and are currently sitting at approximately 10%-15% of our visits being virtual. 3 This is especially true for Medicare beneficiaries, who are a higher risk population for COVID-19 mortality. Before the pandemic, almost every major industry has been transformed due to digital health. For example, the largest retailer is Amazon and traditional entertainment cable TV has reports of telehealth availability and their use. Compared to people who were 75+, younger beneficiaries were more likely to report higher SP telehealth visits since 7/1/2020. In addition, younger beneficiaries were more likely to experience telehealth appointments with their PCP and to use video or voice calls with their physicians. However, younger beneficiaries were also more likely to report that they were unable to obtain care because of COVID-19. Compared to women, men were more likely to report that their SP offered telehealth since 7/1/2020. However, men were less likely to report that their PCP offered telehealth appointments or used video or voice calls with their physicians. Surprisingly, the impact of race and the utilization of telehealth was not significant for most of these services. Only Black non-Hispanics were less likely to report that their PCP offered telehealth appointments than "other" races. Compared to residents who lived in non-metro areas, beneficiaries who lived in metro areas were more likely to report that their PCPs offered telehealth appointments and used video or voice calls; no other telehealth services were significant. were more likely to report that their SP had telehealth visits since 7/1/20, their PCP offered telehealth appointments, and that they used video or voice calls. However, they were also more likely to report an inability to get care because of COVID-19, as shown in Table 3 . With the rapid onset of the COVID-19 crisis, CMS and many private insurance carriers, provided temporary payment parity for telemedicine encounters, and most states eased licensing requirements for telemedicine. 9,10 Using data collected in the CMS Medi- Several studies identified barriers to access and utilization of telemedicine. These include barriers of access to technology such as internet access, a lack of trained staff, limited budgets, a lack of reimbursement, age of the patient, level of patient education, racial and ethnic disparities, and type of community and geographic location. 11, 12 In our analysis, we were able to confirm many of these barriers with more specific insights and recommendations. Internet access was the primary facilitator of telehealth access. Medicare beneficiaries reported increased use of telehealth appointments with internet access. However, they also reported an inability to receive care due to COVID, most likely because many facilities were only offering urgent care. 13, 14 Females utilized telehealth services more than males, which is consistent with the normal patterns of healthcare utilization. 9 However, males showed an increased awareness of specialists' appointments than primary care virtual appointments. This difference may be due to decreased utilization of primary services by males and their propensity only to seek medical assistance when specific medical issues are identified. 9, 14 Previous studies indicated that younger patients were found to be more frequent telehealth users with the highest usage in the 20-44 age groups, especially for urgent care. 15 Our survey confirmed that patients under 75 generally were greater utilizers of telehealth services. The younger group also reported that they were unable to obtain care due to COVID-19, which is consistent with the analysis above of those with internet access. Younger patients generally have higher levels of internet access, utilize telehealth more frequently, and use telehealth for more urgent issues. Telehealth use in rural areas, particularly the Southern regions of the country, as well as among lower-income patients has previously been limited. 16, 17 Lack of resources, internet access, and availability of medical services all contribute to the variance in telehealth use. 10, [18] [19] [20] Within the current analysis, race, surprisingly, was not a significant factor except for Blacks reporting lower awareness of PCP appointments. As a result, policymakers should further assess potential benefits and, based on those assessments, seek to develop policies that best develop telehealth services to respond to future and unexpected barriers to in-person care. Finally, our study indicated that beneficiaries who lived in metro areas were more likely to report that they used telehealth services compared to those in non-metro areas. While more research is needed, this may indicate that infrastructure policies should be considered that encourage the further investment and expansion of affordable and accessible internet services to areas that have either limited, unreliable, or no internet access. These may be more likely located in non-urban and rural areas. Investing in technology infrastructure could have a positive and significant impact on improving the access to healthcare in non-metro areas. There are differences in the populations that used telehealth services, and future research should aim to understand barriers and benefits to telehealth use bet- ter. Subsequently, policymakers should take the current results and knowledge concerning the benefits of telehealth use to establish an appropriate policy to remove barriers and increase usage for populations benefitting from telehealth services. In summary, this survey confirms several barriers to telehealth use and adoption. These include technology and the availability of internet usage, sex, older age, rural locale, lower-income, and regional differences. If telehealth continues to be utilized in the post-COVID-19 era, several areas will need to be actively addressed to ensuring equal access and utilization of telehealth in the future. 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Health Aff (Millwood) Telehealth and rural-urban differences in receipt of pain care in the veterans health administration The transition of academic mental health clinics to telehealth during the COVID-19 pandemic. J Am Acad Child Adolesc Psychiatry Virtually perfect? Telemedicine for Covid-19 Good comes from evil: COVID-19 and the advent of telemedicine in orthopedics Abstract P082: racial/ethnical disparities in the utilization of telehealth services among medicare beneficiaries with atrial fibrillation before the Covid-19 pandemic Disparity in telehealth and emergency department use among Medicaid and commercially insured patients receiving systemic therapy for cancer in Washington state following the COVID-19 pandemic Medicare and telehealth: The impact of COVID-19 pandemic The authors declare no conflict of interest.