Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship

WHY WE DID THIS STUDY

In response to the COVID-19 pandemic, both Congress and the Department of Health & Human Services (HHS) expanded access to a wide range of medical services that can be delivered via telehealth (i.e., telehealth services). This expansion enhanced the ability of health care providers to offer care to Medicare beneficiaries remotely during the COVID-19 pandemic. Prior to the pandemic, beneficiaries were only able to receive certain telehealth services from providers with whom they had an established relationship. However, HHS announced that it will use its discretion to not enforce requirements for established relationships during the pandemic.

While the expansion of telehealth has been essential to maintaining beneficiaries' access to care, there have been concerns about the potential for fraud, waste, and abuse associated with expanded telehealth services. This data snapshot provides information to policymakers and other stakeholders about the relationship between beneficiaries and providers for telehealth services. These data are critical to informing decisions about how to structure telehealth services in Medicare on a more permanent basis. Understanding how likely beneficiaries are to receive telehealth services from a provider with whom they have had an established relationship, and the average timeframe between an in-person visit and a telehealth service, can help inform decisions on how frequently in-person care may need to be paired with telehealth services. This snapshot is part of a series of reports on telehealth; the other reports focus on telehealth utilization and program integrity.

HOW WE DID THIS STUDY

We reviewed Medicare claims data for telehealth services provided from March through December 2020. We determined the proportion of beneficiaries who received telehealth services only from providers with whom they had an established relationship and looked for any differences among the 10 most common types of telehealth services and between beneficiaries enrolled in traditional Medicare and those enrolled in Medicare Advantage. For beneficiaries who had an established relationship with their providers, we determined the average amount of time between their first telehealth service and their most recent in-person visit for each of their providers.

WHAT WE FOUND

Most beneficiaries received telehealth services from providers with whom they had an established relationship. Notably, 84 percent of beneficiaries received telehealth services only from providers with whom they had an established relationship. Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. This pattern persisted among virtually all of the most common telehealth services. Beneficiaries tended to see their providers in person about 4 months prior to their first telehealth service, on average.

WHAT WE CONCLUDE

Data on how likely beneficiaries are to receive telehealth services from a provider with whom they have had an established relationship can be used to inform decisions about how to best use telehealth in Medicare and should be taken into account as policymakers continue to examine telehealth utilization and concerns about telehealth being vulnerable to fraud, waste, and abuse. This includes decisions about which services to allow to be delivered via telehealth on a more permanent basis and to what extent Medicare should require that beneficiaries have a relationship with their providers prior to receiving certain telehealth services.