HHS OIG Report Puts Telehealth Expansion Under Microscope

Two recent reports from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) examine the explosion in the use of telehealth during the pandemic to help policymakers balance concerns about issues such as access, quality of care, cost, health equity, and program integrity as they consider extending widespread access to telehealth.

The Centers for Medicare & Medicaid Services is evaluating the continuation of telehealth services that were temporarily added to during the COVID-19 emergency.

Medicare beneficiaries used 114.4 million telehealth services from March 2020 through February 2021. This amounts to 88 times more telehealth services compared to the year prior to the pandemic, when beneficiaries used 1.3 million telehealth services. Over half of these telehealth services (60.1 million in total) were used by beneficiaries enrolled in Medicare fee-for-service. In total, Medicare paid over $5.1 billion for these services, 76 times more than what it paid for telehealth in the prior year.

In a data brief, OIG found that:

• Beneficiaries in urban areas were more likely than those in rural areas to use telehealth.
• Dually eligible, Hispanic, younger, and female beneficiaries were also more likely than others to use telehealth.
• Almost one-fifth of beneficiaries used certain audio-only telehealth services; the vast majority of these beneficiaries used them exclusively.
• Older beneficiaries were more likely to use certain audio-only services, as were dually eligible and Hispanic beneficiaries.

While beneficiaries used telehealth for a number of different services, beneficiaries’ use of telehealth for behavioral health services stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of all behavioral health services they received during the first year of the pandemic. In contrast, they used telehealth for only 13 percent of all office visits they received during the first year of the pandemic.

OIG said that understanding which services beneficiaries use telehealth for, compared to their use of these services in-person, helps inform questions about how beneficiaries access their healthcare. In particular, beneficiaries’ use of telehealth for behavioral health services relative to their use of these services in-person shows that beneficiaries benefited from the ability to use telehealth for these services. This is further supported by literature prior to the pandemic that suggests the use of telehealth for behavioral health may improve access, especially for beneficiaries facing barriers to care.

OIG has additional evaluations and audits underway examining telehealth in Medicare to help further inform program policies and oversight.

Congress has extended the temporary telehealth expansions for five months after the public health emergency ends. If that deadline comes before long-term telehealth policies have been enacted, OIG recommends that CMS should seek additional authority from Congress to temporarily continue access to telehealth services in urban areas and from the beneficiary’s home. This will ensure that beneficiaries enrolled in Medicare fee-for-service can continue to receive services via telehealth, regardless of geographic location or ability to travel to a health care facility to receive care, while policymakers deliberate and develop more permanent policies for telehealth.

As CMS develops proposals for long-term policies on telehealth, OIG said it should carefully consider the impacts of telehealth flexibilities on beneficiary access to care, health equity, quality, costs, and program integrity.

“As we focus on finding ways to solve for health disparities in our country, this report sheds important light on populations that were most likely to use telehealth, including beneficiaries in urban areas, Hispanic beneficiaries, younger beneficiaries and female beneficiaries,” said Kyle Zebley, senior vice president, public policy at the American Telemedicine Association, and executive director of ATA Action, in a statement. “The OIG report also found that older beneficiaries were more likely to use these audio-only telehealth services,” Zebley added. “The ATA, ATA Action and our members stand ready to work with the Office of the Inspector General to incorporate appropriate oversights and safeguards to maintain telehealth program integrity while ensuring continued and uninterrupted access to lifesaving virtual care services for our Medicare beneficiaries.”