Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future

introduction

Telemedicine, the provision of healthcare services to patients from non-co-located providers, has seen a rapid escalation in usage among both privately insured patients and Medicare beneficiaries during the COVID-19 pandemic. Prior to the pandemic, telehealth coverage under traditional Medicare was limited to beneficiaries living only in rural areas, with restrictions on where beneficiaries could get those services and which providers could be paid to provide those services. Shortly after the federal government declared a public health emergency due to COVID-19 in early 2020, Congress and the Centers for Medicare & Medicaid Services (CMS) expanded Medicare's traditional telehealth coverage to include medical care for beneficiaries facilitate and minimize their exposure to coronavirus in healthcare. However, when the public health emergency ends, Medicare's telehealth coverage will fall back on the limited availability that existed before the pandemic, unless policy makers take action to expand the expanded coverage.

Given the rapid but temporary expansion of telemedicine coverage under traditional Medicare, this report provides an overview of the changes made to Medicare's telemedicine coverage during the COVID-19 pandemic. It will also present a new analysis of Medicare beneficiaries' use of telehealth between Summer and Fall 2020 and discuss issues and issues related to extending telemedicine coverage in traditional Medicare beyond the public health emergency. Our analysis of the use of telehealth services by beneficiaries is based on survey data from the Medicare beneficiaries living in the community from the COVID-19 supplement to the CMS Medicare Current Beneficiary Survey (MCBS) from Fall 2020. All the differences indicated in the text are statistically significant, provided that not stated otherwise. (See Data and Methods for details.)

Main results

Of the vast majority of Medicare beneficiaries with a common source of care (95%) such as a doctor or other health professional or clinic, nearly two-thirds (64% or 33.6 million) say their provider currently offers telemedicine appointments , from 18% who said their provider offered telehealth prior to the pandemic. Almost a quarter of Medicare beneficiaries (23%) say they don't know if their provider offers telemedicine appointments, and that percentage is higher for beneficiaries who live in rural areas (30%).
Among the 33.6 million Medicare beneficiaries with a common care source who said their provider currently offers telemedicine appointments, nearly half (45%) said they had a telemedicine visit to a doctor between summer (July) and fall or another healthcare professional in 2020. That equates to just over 1 in 4 (27% or 15 million) of all community beneficiaries using telemedicine in both traditional Medicare and Medicare Advantage areas during that period (illustration 1).

Figure 1: More than one in four Medicare beneficiaries had a telemedicine visit between summer and fall 2020

Reported telemedicine use among beneficiaries who said their provider offered telemedicine was higher among Medicare beneficiaries under 65 who qualify for Medicare due to long-term disability (53%). Beneficiaries were both Medicare and Medicaid (55%), Black, enrolled (52%), and Hispanic (52%) beneficiaries, and those with 6 or more chronic conditions (56%). For some groups, including Medicare Medicaid participants and those with multiple chronic conditions, higher rates of telemedicine use may be related to higher overall health care utilization. There was no difference in reported telemedicine usage rates between beneficiaries of traditional Medicare and Medicare Advantage (44% and 45%, respectively).
Among Medicare beneficiaries who had a telemedicine visit, a majority (56%) reported accessing care only on a phone, while a smaller proportion reported a telemedicine visit via video (28%) or both video and phone ( 16%). The proportion of Medicare beneficiaries who had telemedicine only by phone was higher among those aged 75 and over (65%), Hispanic beneficiaries (61%), those living in rural areas (65%), and those on both Medicare and the United States also Medicare enrolled people Medicaid (67%).

Background information on Medicare Telehealth coverage and changes in the context of the COVID-19 public health emergency

Prior to the COVID-19 pandemic, telehealth coverage was limited under traditional Medicare. Medicare paid for about 100 services provided by telemedicine, and there were restrictions on how those services could be provided and which beneficiaries could access them. Such restrictions do not apply to Medicare Advantage plans, which are flexible to offer additional telemedicine benefits not covered by conventional Medicare outside of the public health emergency (see below for more information). Prior to the pandemic, telemedicine uptake was extremely low among traditional Medicare beneficiaries. In 2016, only 0.3% of traditional Medicare Part B beneficiaries were enrolled in telemedicine services, which is only 0.4% of traditional Medicare Part B spending. Similarly, analysis of visits to primary care to traditional Medicare found that only 0.1% of those visits before the February 2020 pandemic were via telemedicine.

To make it easier and safer for beneficiaries to obtain medical assistance during the COVID-19 pandemic, the HHS secretary waived certain restrictions on Medicare coverage of telehealth services for traditional Medicare beneficiaries during the COVID-19 emergency in the public health field, based on that in the Coronavirus Preparedness and Response Supplemental Appropriations Act (and as amended by the CARES Act). The Services exemption, effective March 6, 2020, has significantly relaxed telemedicine coverage restrictions under traditional Medicare during the public health emergency, as detailed below. The public health emergency was last renewed in April 2021 and is expected to last for 2021, according to the Biden administration.

Which Traditional Medicare Beneficiaries Can Telemedicine Services Get and Where?

Prior to the public health emergency, telehealth services were generally only available to rural beneficiaries who came from a health service such as a clinic or doctor's office. Beneficiaries in urban areas were not entitled to tele-health services and beneficiaries could not receive tele-health services within their own four walls. During the public health emergency, beneficiaries in any geographic area can receive telehealth services and receive those services in their own homes rather than having to travel to a "remote location" (i.e., a health facility).

What technologies can traditional Medicare beneficiaries use to access telehealth services?

As part of Medicare's existing telemedicine benefit, a telemedicine visit must be carried out with bidirectional audio / video communication. The use of smartphones or audio-only phones in place of video is not permitted. For the duration of the COVID-19 public health emergency, telehealth services can be carried out via an interactive audio-video system and via smartphones with interactive real-time audio / video functions without other devices. In addition, a limited number of telehealth services can be provided to patients via an audio-only phone or a smartphone without video.

What type of providers can Medicare reimburse for telemedicine visits?

Prior to the public health emergency, only doctors and certain other practitioners (such as medical assistants, clinical social workers, and clinical psychologists) were eligible for Medicare payment for telehealth services made available to eligible beneficiaries under traditional medical care, and they must have treated the beneficiary receiving the services in the past three years. During the public health emergency, any health professional qualified to bill Medicare for professional services can provide and bill telehealth services and need not have previously treated the beneficiary. In addition, state-qualified health centers and rural health clinics are allowed to provide telehealth services to Medicare beneficiaries during the COVID-19 public health emergency. These settings were not approved as providers of telehealth services to Medicare beneficiaries prior to the pandemic.

What services can traditional Medicare beneficiaries receive through telemedicine?

Prior to the public health emergency, traditional Medicare covered about 100 services that could be managed through telemedicine, including office visits, psychotherapy, and health screening. During the public health emergency, the list of permitted telehealth services covered by traditional Medicare was expanded to include visits to the emergency room, physical therapy, occupational therapy, and certain other services. Some evaluation and management, behavioral health, and patient education services can only be delivered to patients over audio telephones.

In addition to telemedicine, are there any additional services that are provided virtually and covered by traditional Medicare?

Aside from Medicare's coverage of telehealth services, traditional Medicare includes brief, “virtual check-ins” (also known as “brief communications technology-based services”) by telephone or video, and e-visits for all beneficiaries, whether or not they are are living in a rural area. Both services, unchanged during the public health emergency, are more limited in scope than a full telemedicine visit. For example, virtual check-ins can only be reported by providers who have a committed relationship with the patient, cannot be associated with a recent medical visit (within the last 7 days), and cannot be associated with a medical visit within the next 24 hours lead (or the earliest available appointment and payment is intended to cover only 5-10 minutes of medical discussion.

How does Medicare pay providers for telehealth services?

Prior to the public health emergency, Medicare's payment for a telehealth service was the same whether it was made in an setting outside of a facility such as a doctor's office or in a facility such as a hospital outpatient department, and the payment rate is based on the lower Amount paid to facility-based providers for a personally rendered service. (As per Medicare's Physician Fee Schedule, paying to facility-based providers for personal services is less than paying to non-facility providers because Medicare makes a separate payment to facilities to cover the cost of the practice, such as physical Space and medical supplies, medical equipment and clinical staff time.) The reason for using the lower payment amount for telemedicine services was that the training cost for providing telemedicine services should be lower than for a face-to-face visit.

During the public health emergency, Medicare pays for telemedicine services, including those provided by audio-only phone as if managed in person, with the payment rate varying based on the provider's location, meaning Medicare more a pays for telehealth service provided by a doctor in an out-of-facility setting rather than by a doctor in an outpatient department of a hospital. It also means that doctors in non-public health settings receive a higher payment for telemedicine services during the public health emergency than they did before the public health emergency.

What do traditional Medicare beneficiaries pay for telehealth services?

The cost sharing of beneficiaries for telehealth services did not change during the public health emergency. Medicare covers part B telehealth services. Traditional Medicare beneficiaries who receive these benefits are subject to the Part B Deductible of $ 203 in 2021 and 20% coverage. However, the HHS Inspectorate General has offered flexibility to providers to reduce or waive the cost sharing for telehealth visits during the COVID-19 public health emergency, even though there is no publicly available data indicating the extent to which providers may do so have done . Most traditional Medicare beneficiaries have supplemental insurance that may cover some or all of the cost of covered telehealth services.

How is telemedicine covered under Medicare for beneficiaries and providers participating in alternative payment modes?

Aside from the extended availability of telemedicine services for a limited time, CMS has more flexibility in providing care through telemedicine to providers participating in some alternative payment models, including Next Generation Accountable Care Organizations (ACOs) and Medicare Shared Savings Program ACOs Billing, provides telehealth services to urban and rural beneficiaries, as well as beneficiaries when they are at home. The flexibility in the field of telemedicine for the next generation of ACO demonstrations is guaranteed by waivers managed by CMS to improve performance. From 2016 to 2018, only a few next-generation ACOs received and implemented exceptions for telehealth (4 ACOs; 8% of all ACOs in the model).

How is Telehealth coverage different in Medicare Advantage?

Medicare Advantage plans were able to offer additional telemedicine benefits not covered by traditional Medicare outside of public health emergencies, including telemedicine visits for participants in their own homes and services outside of rural areas. In 2021, virtually all Medicare Advantage plans (98%) will offer a telemedicine benefit.

Medicare Advantage plans receive a capitalized amount from Medicare to provide basic Medicare benefits that fall under Parts A and B. Legislative changes, implemented in 2020, allow plans to add additional telehealth benefits beyond traditional Medicare benefits to their basic benefits offerings. Therefore, the cost of additional telehealth services offered by Medicare Advantage plans is reflected in the capitalized payment that the plans receive.

Medicare Advantage plans provide the flexibility to waive certain coverage and cost-sharing requirements in the event of a disaster or emergency, such as the COVID-19 outbreak. In response to the coronavirus pandemic, CMS has recommended plans to waive or reduce cost sharing for telehealth services, provided that this is consistent for all equal participants. Many Medicare Advantage plans have eliminated or reduced the cost-sharing for subscribers for some or all of the services that are managed through telemedicine during the public health emergency.

Who Utilized Telemedicine Services During the COVID-19 Public Health Emergency?

Knowledge of the availability of telemedicine

As of Fall 2020, six months after traditional Medicare expanded telehealth for the COVID-19 pandemic, nearly two-thirds of Medicare community beneficiaries said they had a common source of care (64% or 33.6 million beneficiaries) , such as a doctor, health care professional, or clinic, reported that their regular provider offers telemedicine appointments from approximately 1 in 5 (18% or 6.1 million) beneficiaries who said their regular provider offered telemedicine prior to the pandemic at (Figure 2;; Table 1). (The majority of Medicare beneficiaries in the community, 95% or 52.7 million, report having a regular care source.) Conversely, 13% of beneficiaries with a regular care source said their provider does not currently offer telehealth . This is a significant decrease compared to 52% who said their provider didn't offer telehealth prior to the COVID-19 pandemic.

While the reported availability of telemedicine increased during the pandemic, nearly a quarter of Medicare beneficiaries with a common source of care (23% or 11.9 million beneficiaries) said they didn't know if their main provider currently offers telemedicine appointments.

Reported rates of beneficiaries who say their provider currently offers telemedicine were similar across most demographic groups (Figure 3). However, a smaller proportion of Medicare beneficiaries living in rural areas than those living in urban areas said their provider currently offers telehealth (52% versus 67%), and a larger proportion of rural beneficiaries say not knowing if their usual provider offers telemedicine appointments as beneficiaries living in urban areas (30% vs. 21%).

A larger proportion of Black Medicare beneficiaries with a common source of care (23%) say their usual provider does not currently offer telemedicine appointments than white (12%) and Hispanic (15%) beneficiaries with a common source of care. In addition, a larger proportion of Medicare beneficiaries enrolled with both Medicare and Medicaid (19%) say that their main provider does not currently offer telemedicine appointments than Medicare beneficiaries who are not both Medicare and Medicaid are enrolled in Medicaid (12%).

Use of telemedicine

Among the two-thirds of Medicare beneficiaries with a usual care source who reported in Fall 2020 that their usual provider offered telemedicine during the pandemic (33.6 million beneficiaries), nearly half (45% or 14.9 million beneficiaries) were a telemedicine visit since July 2020. Some groups of Medicare beneficiaries were more likely than others to report having had a telemedicine visit to a doctor or other health care professional since July 2020, including Medicare beneficiaries under 65 with long-term disabilities, Black and Hispanic beneficiaries . Medicare beneficiaries enrolled in both Medicare and Medicaid, as well as beneficiaries with multiple chronic conditions (Figure 4;; Table 2).

Among Medicare beneficiaries who have a common source of care and whose common provider offers telemedicine:

More than half (53%) of beneficiaries under 65 (who qualify for Medicare because of a long-term disability) had a telemedicine visit, compared with 42% of 65 to 74 year olds and 43% of 75 or 75 year olds older.
A greater proportion of black (52%) and Hispanic (52%) Medicare beneficiaries than white (43%) beneficiaries reported having had a telemedicine visit.
More than half (55%) of beneficiaries enrolled with both Medicare and Medicaid had a telemedicine visit, compared with 43% of Medicare beneficiaries who were not enrolled with Medicaid.
A greater proportion of beneficiaries with 6 or more chronic illnesses reported having a telemedicine visit than those with zero or 1 chronic illness (56% versus 33%), and half or more of Medicare beneficiaries with certain chronic conditions had a telemedicine visit , including people with diabetes (50%), heart disease (50%), emphysema, asthma or COPD (54%), and depression (55%), and people with compromised immune systems (59%).
A similar proportion of Medicare Advantage participants and beneficiaries of traditional Medicare have had a telemedicine visit since July 2020 (45% and 44%, respectively) (Table 2).
Medicare beneficiaries reporting a telemedicine visit between Summer and Fall 2020 make up 1 in 4 total Medicare beneficiaries (27% or 14.9 million beneficiaries) based on the total population of beneficiaries living in shared apartments that include beneficiaries who said they did not have a telemedicine visit, beneficiaries who do not know if their provider offers telemedicine, and those without a usual source of care who were not asked about their use of telemedicine (Figure 4, Table 2).

In particular, among Medicare beneficiaries with a common source of care and their common provider offering telemedicine, we found no significant difference between the proportions of rural and urban Medicare beneficiaries who had a telemedicine visit (43% and 45%, respectively). However, relative to the general population in these groups, rural Medicare beneficiaries were less likely to have a telemedicine visit to a doctor or other health care professional than urban beneficiaries (21% versus 28%). This difference is likely due to the fact that rural Medicare beneficiaries were more likely than urban Medicare beneficiaries to report not knowing if their mainstream provider offered telehealth (30% versus 21%).

Similarly, for Medicare beneficiaries with a common care source whose main provider offers telemedicine, we found that a greater proportion of Black and Hispanic beneficiaries had a telemedicine visit than white beneficiaries (52%, 52%, and 43%). Among the entire Medicare population, the difference in the proportion of black and white beneficiaries reporting a telemedicine visit was not statistically significant (30% versus 26%), while a larger proportion of Hispanic beneficiaries than the white beneficiaries had a telemedicine visit (33% versus 26%). For Black Medicare beneficiaries, this finding is likely related to the fact that nearly a quarter of Black beneficiaries overall (23%) say their usual provider doesn't offer telemedicine appointments, compared to 12% of White beneficiaries and 15% of Hispanic beneficiaries.

How did the beneficiaries access telemedicine services?

Among Medicare beneficiaries with a common care source whose provider offers telemedicine appointments, the majority of those who had a telemedicine visit since July 2020 have accessed the service by phone (56%), compared with 28% who said have a telemedicine visit via video and video 16% used both telephone and video (Figure 5;; Table 3). This may be related to the fact that more than 8 in 10 Medicare beneficiaries say they have internet access (83%), but smaller proportions say they have a computer (64%) or smartphone (70%) (Figure 6, Table 4).

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There are notable differences across demographics in terms of beneficiaries' access to telemedicine services during the pandemic and the availability of technologies that enable access to telemedicine, for example:

Two thirds (65%) of beneficiaries aged 75 and over had a telemedicine visit that was only carried out by telephone, compared with just over half (52%) of 65 to 74 year olds. These results likely reflect the lower proportion of Medicare beneficiaries aged 75 and over who report having access to the Internet or a computer compared to those aged 65 to 74 (74% vs 89%) (56% vs 74%) or own a smartphone (53% versus 80%).
Six in ten (61%) Hispanic Medicare beneficiaries had a telemedicine visit that was done by phone only, compared to 54% of White beneficiaries, likely due to a smaller proportion of Hispanic Medicare beneficiaries than White beneficiaries reported having access to the Internet (67% versus 86%) and a much smaller proportion of Hispanic beneficiaries than white beneficiaries report having a computer (34% versus 71%). Similarly, only 42% of Black Medicare beneficiaries own a computer compared to 71% of White beneficiaries, but the difference in the proportion of beneficiaries reporting a telemedicine visit by phone only was not significant for Black and White beneficiaries differently.
Rural beneficiaries were more likely than those living in urban areas to report a telemedicine visit that was only by phone (65% vs 54%), likely due to lower internet access rates for rural beneficiaries than urban beneficiaries (78% vs.5%) 84%) and possession of computers (58% versus 66%) or smartphones (60% versus 72%).

Looking to the Future: Extending Medicare Coverage for Telemedicine Beyond the Pandemic

Our analysis found that one in four Medicare beneficiaries had a telemedicine visit during the COVID-19 public health emergency, a significant increase in usage since before the pandemic. Our finding that greater proportions of people with disabilities, low incomes and color communities have used telemedicine among beneficiaries whose providers offer telemedicine suggests that the temporary expansion of telemedicine coverage may help some of the Disadvantaged populations of Medicare continue to be disadvantaged to access needed care. At the same time, given our finding that a quarter of Medicare beneficiaries overall (and an even larger proportion of those in rural areas) do not know whether their doctor currently offers telemedicine, we are working to raise awareness of telemedicine services covered by Medicare while to sharpen the public health emergency could help widen its reach.

A number of proposals are currently being considered by policy makers to extend some or all of the existing flexibilities related to telehealth services under Medicare beyond the public health emergency, and many have expressed support for this. Telemedicine-related bills introduced at the 117th Congress include proposals to provide permanent coverage for some of the telemedicine enhancements provided during the public health emergency, expansion of Medicare-covered mental health services, and telemedicine-managed evaluation services. and administrative services and to expand the scope of providers eligible to pay for Medicare-covered telehealth services. Other bills aim to assess the impact of enhanced telehealth services on the quality of patient care and program spending.

As part of Medicare's existing telemedicine benefit, a telemedicine visit must be conducted using two-way audio / video technology, while the current public health emergency exemption allows a limited number of patient telemedicine services to be provided via audio only. Telephone can be provided. Given that the majority of Medicare beneficiaries in our analysis stated that they only access telemedicine services by phone, an extended telemedicine benefit that requires two-way video communications could pose an obstacle to serving subsets of the Medicare population, who relied more on phones than video. fähige Geräte während der Pandemie.

MedPAC hat Medicare empfohlen, eine modifizierte Version der erweiterten Telemedizin-Deckung für ein oder zwei Jahre nach dem Ende des Notfalls im Bereich der öffentlichen Gesundheit fortzusetzen, damit Medicare Zeit hat, die Auswirkungen der Telemedizin-Nutzung auf die Gesamtkosten, den Zugang und die Qualität der Versorgung zu bewerten. Während dieser zusätzlichen Zeit empfiehlt MedPAC Medicare, für bestimmte Telegesundheitsdienste zu zahlen, unabhängig davon, wo ein Begünstigter lebt. einige zusätzliche Telegesundheitsdienste abdecken, die über die vor dem Notfall im Bereich der öffentlichen Gesundheit abgedeckten hinausgehen, wenn das Potenzial für einen klinischen Nutzen besteht; und Telemedizinbesuche nur mit Audio abdecken, wenn das Potenzial für einen klinischen Nutzen besteht. MedPAC hat außerdem empfohlen, die Zahlung für Telegesundheitsdienste nach dem Notfall im Bereich der öffentlichen Gesundheit auf die niedrigere einrichtungsbasierte Zahlungsrate zurückzusetzen, die vor der Pandemie gilt, und den Anbietern nicht zu gestatten oder die Kostenbeteiligung der Begünstigten zu verringern.

Eine erweiterte Abdeckung der Telegesundheit über den Notfall im Bereich der öffentlichen Gesundheit hinaus könnte die Qualität der Patientenversorgung sowie die Ausgaben für Programme und Begünstigte beeinträchtigen. Eine Ausweitung der Telegesundheitsversorgung hat das Potenzial, den Zugang zu notwendiger Pflege zu verbessern, es besteht jedoch Unsicherheit darüber, ob dies zu einer allgemeinen Erhöhung oder Verringerung der Programmausgaben führen würde. Einige Telegesundheitsdienste können Ersatz für die persönliche Betreuung sein, z. B. ein verhaltensbezogener Gesundheitsbesuch, obwohl ein einfacherer Zugang zu Telegesundheit zu einem allgemeinen Anstieg der Besuche und Kosten führen kann. Andere Telegesundheitsdienste ersetzen möglicherweise nicht vollständig die Notwendigkeit (oder das Auftreten) eines persönlichen Besuchs, z. B. einen Besuch zur Beurteilung eines Hautausschlags oder wenn festgestellt wird, dass Laborarbeiten erforderlich sind. Durch die Erstellung von Belegen für die Kosten- und Qualitätsauswirkungen der Nutzung von Telemedizin in Medicare könnte die Verwaltung möglicherweise auch Erkenntnisse gewinnen, die auf der Nutzung von Telemedizin durch Teilnehmer an Medicare Advantage-Plänen beruhen, oder indem sie verschiedene Ansätze mithilfe von Center for Medicare- und Medicaid Innovation-Modellen testet.

Die potenzielle Ausweitung der Telemedizin-Abdeckung bringt Bedenken hinsichtlich des Potenzials betrügerischer Aktivitäten mit sich. In den letzten Jahren gab es mehrere große Betrugsfälle mit Telegesundheitsunternehmen, von denen die meisten die Einreichung betrügerischer Ansprüche für Gegenstände, Dienstleistungen und Tests bei Medicare und anderen Versicherern betrafen, die Patienten niemals gegeben oder verabreicht wurden. Das HHS-Büro des Generalinspektors (OIG) führt mehrere Studien durch, um die Angemessenheit der Nutzung von Telemedizin während des Notfalls im Bereich der öffentlichen Gesundheit zu bewerten, einschließlich einer Analyse der Abrechnungsmuster von Anbietern, um Anbieter zu identifizieren, die ein Risiko für die Programmintegrität darstellen könnten, und eine Prüfung von Telegesundheitsdiensten gemäß Teil B, um sicherzustellen, dass die Dienste die Medicare-Anforderungen erfüllen. MedPAC hat empfohlen, dass Medicare Ausreißerklinikern, die mehr Telegesundheitsdienste als andere anbieten, eine zusätzliche Prüfung unterzieht und persönliche Besuche erfordert, bevor Kliniker teure Geräte oder Dienstleistungen für Begünstigte bestellen können.

Die vorübergehende Ausweitung der Abdeckung für Telegesundheitsdienste hat es vielen Medicare-Patienten ermöglicht, während der Coronavirus-Pandemie Zugang zu medizinischer Versorgung zu erhalten. Angesichts der Tatsache, dass der vorübergehende Verzicht auf Beschränkungen der Abdeckung von Telegesundheitsdiensten im Rahmen von Medicare mit dem Ablauf des Notfalls im Bereich der öffentlichen Gesundheit ein Ende haben wird, stellt sich die Frage, ob und wie der fortgesetzte Zugang zu diesen Diensten sichergestellt werden kann, während Bedenken hinsichtlich der Qualität der Versorgung und des Gesundheitswesens abgewogen werden Ausgaben, droht groß.

Diese Analyse verwendet Umfragedaten für Medicare-Begünstigte in Wohngemeinschaften aus der Medicare Current Beneficiary Survey (MCBS) der Centers for Medicare & Medicaid Services (CMS), Herbst 2020 COVID-19 Community Supplement. Die Ergänzung zu MCBS Fall COVID-19 enthält mehrere Umfragefragen, mit denen der Zugang der Medicare-Begünstigten zur Versorgung und Nutzung von Telegesundheitsdiensten von Juli 2020 bis Herbst 2020 bewertet werden soll.

Um den Anteil der Medicare-Begünstigten zu bestimmen, deren Anbieter Telemedizin anbietet, haben die Begünstigten die Frage positiv beantwortet: „Gibt es einen bestimmten Arzt oder eine andere medizinische Fachkraft oder eine Klinik, in die Sie normalerweise gehen, wenn Sie krank sind, oder um Ratschläge zu Ihrer Gesundheit zu erhalten? ” (9.216 von 9.686 Befragten) wurden gefragt: "Bietet Ihr üblicher Anbieter Telefon- oder Videotermine an, damit Sie ihr Büro oder ihre Einrichtung nicht physisch besuchen müssen?" (5.644 Befragte antworteten positiv).

Um den Anteil der Medicare-Begünstigten zu bestimmen, die einen Telemedizinbesuch hatten, wurden Begünstigte mit einer üblichen Pflegequelle, deren üblicher Anbieter Telemedizintermine anbietet, gefragt: „Haben Sie seit dem 1. Juli 2020 einen Termin bei einem Arzt oder einer anderen medizinischen Fachkraft von Telefon oder Video? " (2.515 Befragte antworteten positiv). In ähnlicher Weise wurden Leistungsempfänger mit einer üblichen Pflegequelle, deren Anbieter Telemedizin anbietet, gefragt: "Hat Ihr üblicher Anbieter vor der Coronavirus-Pandemie Telefon- oder Videotermine angeboten?" (1.035 Befragte antworteten positiv).

Um festzustellen, wie Begünstigte auf Telemedizin-Termine zugegriffen haben, wurden Begünstigte, die seit Juli 2020 einen Telemedizin-Termin hatten, gefragt: „War es ein Telefontermin, ein Videotermin oder beides?“ The majority of Medicare beneficiaries who had a telehealth visit since July 2020 had a visit via telephone (n=1,460), while fewer had a telehealth visit via video (n=653) or via both telephone and video (n=393).

Based on the questionnaire skip patterns, beneficiaries were only asked about their use of telehealth if they answered affirmatively that they had a usual source of care and that their usual provider offers telehealth. In order to determine the share of Medicare beneficiaries who had a telehealth visit among Medicare beneficiaries overall, we created a categorical variable that included beneficiaries whose provider did not offer telehealth or it was unknown. The variable had three categories: 1) usual provider offers telehealth and beneficiary had a telehealth visit (n=2,515); 2) usual provider offers telehealth and beneficiary did not have a telehealth visit (n=3,074); 3) usual provider does not offer telehealth or it was unknown (n=4,097).

Results from all statistical tests were reported with p<0.05 considered statistically significant.