Pre-pandemic, Medicare beneficiaries could access telehealth only under limited circumstances — mainly, if they lived in a designated rural area and traveled to a federally qualified health center (FQHC) to receive care. Medicare would reimburse providers for telehealth visits only if both audio and visual components were used.
For older, low-income Americans, particularly those living in rural areas but also many living in urban and even suburban areas, these requirements could make accessing telehealth difficult, which is largely counterproductive to its intent. Many who stand to benefit from virtual care options face barriers to in-person care, such as mobility challenges, lack of transportation or a shortage of providers in close proximity.
These same individuals may also lack the technology or broadband capacity to meet Medicare’s interactive audio and video telecommunications requirement. According to the Pew Research Center, less than 65% of rural residents report having a home broadband internet connection, and more than 40% of low-income Americans lack home broadband services.
Surely, there’s a better way — a way to harness the potential of telehealth to enable access to care for vulnerable populations, rather than exacerbate existing health disparities. Turns out, there is, and we’re seeing the impact of it right now.
Removing Barriers to Telehealth Access
In March 2020, the Centers for Medicare and Medicaid Services (CMS) issued several temporary actions to expand telehealth for Medicare beneficiaries during the COVID-19 public health emergency (PHE), allowing providers to:
- Conduct telehealth with patients in their homes and outside of designated rural areas
- Provide remote telehealth care, including across state lines
- Deliver care to both current and new patients through telehealth
- Bill for both video and audio-only telehealth services as if they were rendered in person
Of CMS’ COVID-19-driven changes to telehealth, permitting the use of audio-only communications has had perhaps the strongest impact and presents significant potential for a more equitable future. A JAMA analysis of 41 FQHCs in California during the pandemic revealed that 48.5% of primary care visits occurred via telephone, compared to 48.1% in person and just 3.4% through video. Demographically, research from the University of Alabama at Birmingham cited by Helio shows that African Americans, adults ages 60 and older and Medicare and Medicaid members are less likely to use video compared to other groups.
Sticking With What Works
Largely intended to facilitate continuity of care while protecting against COVID-19, CMS’ temporary rules are due to expire at the end of the PHE. However, a bill introduced in the House of Representatives proposes to extend the use of audio-only telehealth services for seniors enrolled in Medicare Advantage plans.
The Ensuring Parity in MA and PACE for Audio-Only Telehealth Act would permanently allow certain audio-only diagnoses to be used in determining risk adjustment for Medicare Advantage (MA) and Program of All-Inclusive Care for the Elderly (PACE) members. It would also continue to ensure providers are reimbursed for audio-only telehealth services as if they were rendered in person.
Building an Equitable, Consumer-Centric Environment
The bipartisan telehealth bill has garnered widespread support from healthcare organizations and industry associations alike, including America’s Physician Groups, America’s Health Insurance Plans and the American Psychological Association — and with good reason. Though telehealth has for years been promoted as a means of reducing healthcare gaps, adoption has been slow. Now, with an urgent health crisis necessitating safe, convenient and continuous access to care outside of the traditional clinical setting, we can more clearly see the potential of telehealth — and better understand the framework needed to support its meaningful use.
The COVID-19 PHE will eventually come to an end; however, the healthcare needs of those who have come to rely on the telephone as a healthcare lifeline during the pandemic will endure in its aftermath. While closing the digital divide in underserved communities remains an urgent priority, these disparities should not in the interim prevent people from accessing the care they need through whatever means feasible.