Telehealth visits increased, but overall utilization of Part B declined
A government report from the Assistant Secretary for Planning and Evaluation’s Office of Health Policy found that the number of Medicare fee-for-service visits increased dramatically in 2020 compared to 2019. In 2019, there were 840,000 Medicare FFS telehealth visits compared to 52.7 million in 2020.
Despite the massive increase in telehealth visits during the pandemic, total utilization of all Medicare Part B clinician visits declined about 11% in 2020 compared to 2019.
The vast majority of beneficiaries (92%) received telehealth visits from their homes, which was not permissible in Medicare prior to the pandemic. Telehealth made up less than 1% of visits across all visit specialties but increased substantially in 2020.
Primary care saw an 8% increase in telehealth visits, while specialty care had the smallest shift toward telehealth, with a 3% increase. Primary care saw a 24-fold increase in telehealth visits from pre-pandemic levels. Visits to behavioral health specialists showed the largest increase in telehealth in 2020, accounting for a third of total visits.
Demographically, Black and rural beneficiaries had lower use of telehealth compared with White and urban beneficiaries, respectively. Telehealth use varied by state, with higher use in the Northeast and West, and lower in the Midwest and South. Similar geographic patterns of telehealth were observed in private claims data for commercial payers. The report states this may be a reflection of a combination of factors, including different state telehealth policies during the pandemic, existing provider capacity, and readiness for rapidly expanding telehealth, and high rates of COVID-19 case precipitating lock-downs, particularly in the early months of the pandemic.
States with the highest use of telehealth in 2020 included Massachusetts, Vermont, Rhode Island, New Hampshire, and Connecticut. States with the lowest use of telehealth in 2020 included Tennessee, Nebraska, Kansas, North Dakota, and Wyoming. Despite the highest uptake of telehealth in the Northeast, some of these states also had the highest net decrease in health care utilization since the start of the pandemic, such as Maine (-22.5%), Connecticut (-17.7%), New Jersey (-16.5%), Massachusetts (-16.3%), and New Hampshire (- 16.1%). The report states that both of these could be responses to the early surge of COVID-19 cases in the Northeast, resulting in lower health care use and higher uptake in telehealth.
The report concludes: “Our findings showing net decline in health care utilization in 2020 – despite large increase in telehealth – underscore the need to carefully consider the extension of Medicare telehealth flexibilities after the pandemic ends and evaluate the impacts of telehealth on patient access, health care quality, and health outcomes.”