About one in six doctor offices by older Americans no longer takes place in a real doctor’s office, but rather online than over the phone, a new analysis of telehealth visits that Medicare found over the past two years.
The total number of such visits – the kind aimed at evaluating a medical condition as a symptom and making a management plan – did not increase from 2019 to 2020, the analysis shows.
This is despite some concerns that widespread access to telehealth due to the COVID-19 pandemic would lead to an increase in the total number of such visits.
But the data highlights another concern about telehealth: access problems for older adults living in rural parts of the country.
The report shows that about a third of rural older adults had at least one virtual visit in 2020, compared to nearly half of their counterparts in suburbs and urban areas.
The 2019 and 2020 Medicare data analysis, published as a short report by the University of Michigan Institute for Healthcare Policy and Innovation, suggests that policymakers may need to focus on ways to increase telehealth use by rural older adults. It also provides information that may inform post-pandemic payment decisions for telehealth visits by Medicare, which has treated virtual visits under special emergency rules.
Prior to the pandemic, Medicare’s telehealth facilities targeted mainly rural areas, to increase access to specialists through virtual visits from their local doctor’s office, but admissions were low. In the pandemic era, coverage for telehealth has allowed a fixed percentage of evaluations and agreements of management to actually be carried out. For the most part, these visits have been a substitute for personal care. “
Chad Ellimoottil, MD, MS, Study Lead Author of the UM Brief Report and Assistant Professor of Urology, Michigan Medicine
Ellimoottil directs IHPI’s Telehealth Research Incubator, which has produced other reports on telehealth trends and attitudes since before the pandemic.
At the height of the first pandemic outbreak in April 2020, about half of Medicare participants’ appointments to evaluate medical care and get a recommendation for treatment took place online or over the phone.
That dropped to a lower, but constant, rate between 13.5% and 18.3% for the rest of 2020. But the total number of evaluations and management appointments did not exceed the median number of such visits in 2019 – and in fact , on the very older adults had fewer such appointments for the whole of 2020. This suggests that telehealth visits are used as a substitute for personal care, not a supplement, and that some adults avoid care.
Michigan Medicine – University of Michigan