Trends in telehealth use by Medicare fee-for-service beneficiaries and its impact on overall volume of healthcare services
1Department of Urology, University of Michigan, Ann Arbor
2Department of Cardiac Surgery, University of Michigan, Ann Arbor
3Institute for Healthcare Policy & Innovation, Ann Arbor
*Corresponding: Chad Ellimoottil, MD, MS, Assistant Professor of Urology, University of Michigan, Director, Telehealth Research Incubator, Institute for Healthcare Policy and Innovation, 2800 Plymouth Rd, Bldg 16, 1st Floor, Room 152S, Ann Arbor, MI 48109, cellimoo@med.umich.edu, Office: 630-440-4458ABSTRACT
Introduction
At the start of the COVID-19 public health emergency, the federal government made temporary Medicare policy changes to expand telehealth coverage, resulting in a surge in telehealth use. As federal and state policymakers currently consider permanent telehealth policy options, it is important to understand the trends in telehealth use during 2021 and whether telehealth has led to an increase in the overall volume of healthcare services.
Methods
Our analysis was conducted using Part B claims for 100% of Medicare fee-for-service beneficiaries. We identified all outpatient evaluation and management (E&M) services received by beneficiaries from January 1, 2019 through December 31, 2021. We then calculated the monthly proportion of outpatient E&M services that were performed in-person and through telehealth.
Results
The total number of all outpatient E&M services was 289.0 million in 2019, 255.2 million in 2020 (11.7% lower than 2019), and 260.7 million in 2021 (9.8% lower than 2019). Monthly telehealth services peaked at 7.2 million (or 50.7% of monthly E&M services) in April 2020, followed by a slow decline through the end of 2021. During the second half of 2021, telehealth services made up 8.5-9.5% of monthly E&M services.
Conclusion
From April 2020 through December 2021, the monthly volume of telehealth services slowly declined and has plateaued between 8.5-9.5% of all outpatient E&M services received by Medicare fee-for-service beneficiaries. Importantly, the total volume of outpatient E&M services was lower in 2020 and 2021, suggesting that the COVID-19 telehealth flexibilities have not increased the overall volume of outpatient E&M services received by Medicare beneficiaries. These findings should mitigate some concerns about the impact of telehealth on overall healthcare utilization.
At the start of the COVID-19 public health emergency, the federal government made temporary Medicare policy changes to expand telehealth coverage, resulting in a surge in telehealth use.1,2 While telehealth was a necessary substitute for in-person care during first few months of the pandemic, there was a decline in the use of telehealth during the second half of 2020.3 As federal and state policymakers currently consider permanent telehealth policy options, it is important to understand the trends in telehealth use during 2021 and whether telehealth has led to an increase in the overall volume of healthcare services.
Article notes
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This study was funded by: 1 K08 HS027632-01 (Ellimoottil) 1R01HS028397-01A1 Agency for Healthcare Research and Quality (Ellimoottil and Thompson) University of Michigan Faculty Catalyst (Ellimoottil)
METHODS
Our analysis was conducted using Part B claims for 100% of Medicare fee-for-service beneficiaries. For each year of our study, we excluded patients who were not enrolled in Medicare Part B or were enrolled in Medicare Advantage. For our first analysis, we identified all outpatient evaluation and management (E&M) services received by beneficiaries from January 1, 2019 through December 31, 2021. We identified telehealth services using Medicare’s list of eligible telehealth services and the appropriate modifier codes (GT, GQ, 95) or place of service code (02) corresponding to each year of the study. We also identified telehealth services using Healthcare Common Procedure Coding System codes for selected virtual care services including phone visits, virtual check-ins, online digital evaluations, interprofessional consultations, and remote monitoring. We then calculated the monthly proportion of outpatient E&M services that were performed in-person and through telehealth.
For our second analysis, we categorized all beneficiaries who received outpatient E&M services from January 1, 2021 through December 31, 2021 as telehealth users if they received at least one telehealth service and telehealth non-users if they did not receive any telehealth services. We then compared the characteristics of telehealth users and non-users. We used SAS Enterprise Guide (version 7.15) and the institutional review board determined the study was exempt.
RESULTS
The total number of all outpatient E&M services was 289.0 million in 2019, 255.2 million in 2020 (11.7% lower than 2019), and 260.7 million in 2021 (9.8% lower than 2019). Monthly telehealth services peaked at 7.2 million (or 50.7% of monthly E&M services) in April 2020, followed by a slow decline through the end of 2021 (Figure 1). During the second half of 2021, telehealth services made up 8.5-9.5% of monthly E&M services.
In 2021, 33% of Medicare beneficiaries received at least one telehealth service. (Table 1) Rural beneficiaries utilized telehealth less often than their non-rural counterparts (17% vs 26%). Only minor differences were noted between telehealth users and non-users in regard to age, gender, race and Medicaid eligibility (dual-eligible) status.
DISCUSSION
From April 2020 through December 2021, the monthly volume of telehealth services slowly declined and has plateaued between 8.5-9.5% of all outpatient E&M services received by Medicare fee-for-service beneficiaries. Importantly, the total volume of outpatient E&M services was lower in 2020 and 2021, suggesting that the COVID-19 telehealth flexibilities have not increased the overall volume of outpatient E&M services received by Medicare beneficiaries. These findings should mitigate some concerns about the impact of telehealth on overall healthcare utilization. This study was limited by the fact that it did not include a small percent of claims received more than three months after the end of 2021.
Conflict of interest disclosures
No funding organization was involved in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.
Grant support
1 K08 HS027632-01 (Ellimoottil)
1R01HS028397-01A1 Agency for Healthcare Research and Quality (Ellimoottil and Thompson)
University of Michigan Faculty Catalyst (Ellimoottil)
Data Availability
All data in the present study are publically available through the Chronic Conditions Data Warehouse