Preliminary report
of data shows steady level of virtual visits substituting for in-person visits.
June 23, 2022 10:47 AM Jacob Dwyer, Justine Ross, Michigan Medicine
Older Americans and their health care
providers have settled into a steady pattern of using telehealth technology
for nearly 1 in 10 outpatient appointments ,
a new analysis of Medicare data shows.
That level of virtual visits persisted
throughout the entire latter half of 2021, according to the findings from a
University of Michigan team. In all, 1 in 3 people with traditional Medicare
coverage saw a health care provider virtually at least once in 2021.
Meanwhile, in-person visits declined
during that same time and in general since 2019. That’s contrary to concerns
about a “runaway” increase in total visits after telehealth rules relaxed
suddenly in early 2020 due to the COVID-19 pandemic.
Now that those temporary rules may be
nearing their 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. That order was renewed in April and since no
notification has been issued that it will be allowed to expire in mid-July, is
likely to be extended for additional months.
That’s why the researchers from U-M’s
Institute for Healthcare Policy and Innovation chose to publish their findings
now, as a preprint ahead of peer review.
“As telehealth use hits its stride in
the Medicare fee-for-service population, the fears that flexible telehealth
rules might lead to an increase in the total volume of outpatient visits has
not panned out,” said Chad Ellimoottil, M.D., M.S., lead author of the new
preprint and leader of IHPI’s Telehealth Research Incubator lab. “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.”
Ellimoottil said that more analysis is
needed to determine if the lower volume of outpatient services used by the
Medicare fee-for-service population is because older adults are still foregoing
routine care.
The new analysis shows that for the
second half of 2021, about 9% of all outpatient appointments by people with
traditional Medicare coverage took place over video or audio connections.
That’s a decline from telehealth connections made from mid-2020 through
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 done in person declined 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 deaths or
shifts to Medicare Advantage.
The team previously published a report on telehealth use for Medicare evaluation and
management visits in 2019 and 2020.
Both the previous and new analyses show
that use of telehealth was lower among older adults living in rural areas. In all,
17% of rural older adults with traditional Medicare had at least one telehealth
appointment between 2019 and 2021, compared with 26% of older adults living in
non-rural areas. No other major disparities were found.
Paper cited: "Trends in
telehealth use by Medicare fee-for-service beneficiaries and its impact on
overall volume of healthcare services," DOI: 10.1101/2022.06.15.22276468
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