The Doctor Will See You Now (Virtually) 

The COVID-19 pandemic has created new obstacles to patient access to health care, necessitating resourceful solutions such as the incorporation of telehealth services by health care systems. 

Prior to COVID, telehealth had been slowly and narrowly introduced as an option for those who had the financial and technological ability to connect online to the few participating clinicians. Medicare patients were further limited because Medicare only covered rural residents with a narrow collection of practitioners and services. 

During the pandemic, CMS and Congress expanded Medicare’s telehealth coverage in an effort to remove barriers to access and to limit COVID exposure. This coverage will revert to its pre-pandemic status unless policymakers make the change permanent (see introduced bill CONNECT for Health Act of 2021).

Effective March 6, 2020, CMS enabled Medicare to pay for three kinds of telemedicine services: telehealth visits, virtual check-ins, and e-visits. Patients were now permitted to seek services ranging from 5-minute phone calls to full-fledged office appointments on a video platform. Various emergency department visits were also covered, including tele-triage to divert patients from highly burdened areas, improving ED saturation and avoiding risk of exposure. 

Although privacy and security were previously major barriers to this platform, concessions are being made. The HHS Office for Civil Rights now waves HIPAA violations against clinicians serving patients through everyday communications technologies, such as FaceTime or Skype, regardless of whether the service was directly related to COVID during the public health emergency. 

The use of telehealth services was studied by Chang et al showing that a wide range of clinicians began to offer remote appointments to patients including Medicare beneficiaries. Most patients had one or more pieces of equipment (mainly telephones) to connect, and Black, Hispanic, and male Medicare patients were more likely to use telehealth services than their counterparts. As expected, older patients, those with a lower income, and non-English speakers had less access to telehealth equipment, highlighting obstacles to equitable availability. This study is however limited as it was done at the beginning of the pandemic, and further investigation into changes in use over the past few years will be necessary as the data become available.

As telehealth continues to grow, and as we encourage policy makers to remove barriers, it will become increasingly necessary to ensure that we do not leave behind those in hard-to-reach rural areas and resource-vulnerable populations. 

With patients and clinicians becoming more familiar and dependent on the option of telehealth, it seems likely it will be here to stay in some form, even after the pandemic.

This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Emergency Medicine Residents’ Association. This review was written by Caroline Bradford, an EMRA member and medical student at Liberty University College of Osteopathic Medicine.

Abstract

Context: During the COVID-19 pandemic, demand for telehealth services increased to reduce disease exposure for patients and providers and to meet preexisting demand for physician services in health resource shortage areas.

Objective: To estimate self-reported telehealth availability, equipment for accessing telehealth, and telehealth usage among Medicare beneficiaries during the COVID-19 pandemic.

Design: We used data from the 2020 Medicare Current Beneficiary Survey (MCBS) COVID-19 Fall Supplement Public Use File to estimate the weighted percentages of beneficiaries who had (a) access to telehealth before or during COVID-19; (b) equipment for accessing telehealth; and (c) telehealth visits during COVID-19. We used logistic regression to examine sociodemographic factors associated with telehealth usage.

Participants: Beneficiaries who participated in the MCBS COVID-19 Fall Supplements.

Results: During October and November 2020, telehealth appointments offered by providers were available to 63.8% (95% confidence interval [CI], 61.8-65.9) of Medicare beneficiaries who had accessed medical care by telephone or video. Among those, only 18.0% (95% CI, 16.1-19.9) had been offered telehealth before the pandemic. The majority of beneficiaries (92.2%; 95% CI, 91.2-93.1) had 1 or more types of equipment available for accessing telehealth, but only 44.9% (95% CI, 43.0-46.9) had had a telehealth visit since July 1, 2020. Older adults, minorities, those with a lower income, and non-English speakers had less availability of telehealth equipment. Patient characteristics were significantly (P < .05) associated with telehealth use, including age, sex, race/ethnicity, and equipment availability.

Conclusion: Telehealth availability for Medicare beneficiaries increased substantially during the COVID-19 pandemic. Even with the improvement in telehealth offerings and use hastened by the pandemic, gaps in access and use still exist. Effectiveness and implementation research can find ways to close gaps in telehealth services between vulnerable and underrepresented populations and counterparts.

Chang et al.  Public Health Manag Pract . 2022 Jan-Feb 01;28(1):77-85.