In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing the four required elements, including the following:
- Identification of Medicare beneficiaries whose care may be improved most by telehealth services;
- Activities by the Center for Medicare and Medicaid Innovation that examines the use of telehealth;
- The types of high-volume services that might be suitable to be furnished using telehealth; and
- The barriers that are preventing telehealth’s expansion.
The document employs data from Medicare Fee for Service (FFS) between 2014 and 2016, reporting that although overall use of telehealth has increased, the rate of adoption is still limited. For example, in 2016, approximately 90,000 Medicare beneficiaries utilized 275,199 telehealth services which constitutes just one-quarter of a percent of the 35 million FFS Medicare beneficiaries. Mental health and therapy sessions were the most common service types, with beneficiaries with a mental health diagnosis among the highest utilizers of telehealth delivered services. Services targeting chronic diseases and behavior modification (such as smoking cessation) were also among the more popular telehealth delivered services. One of the most illuminating findings from the report was that if only 1% of Medicare’s in-person visits occurred over telehealth, it would result in a thirteen fold increase in telehealth delivery. The analysis determined that there are 19 additional high volume services for outpatient and inpatient visits and therapy that are either similar to those that are already on Medicare’s list or that are typically provided in settings that do not meet Medicare’s originating site requirements that would be suitable for telehealth delivery.
The report also recognizes the role telehealth could play in fighting substance use disorder, citing studies that indicate improved results for telehealth SUD treatment programs’ completion rates compared to in-person programs. The report states that “telehealth seems to provide the intervention most similar to office-based treatment, and research shows that telehealth patients, while not specific to Medicare, have satisfaction levels and outcomes similar to those of clients receiving in-person therapy.”
CMS concludes that restrictions on eligible telehealth originating sites is the greatest barrier preventing the expansion for telehealth within Medicare. Specifically the requirement the beneficiary be located in a rural area and excluding the home as an originating site (with the exception of certain conditions) has resulted in the low utilization levels. The report acknowledges telehealth’s potential not only for Medicare rural beneficiaries but also to those in non-rural areas, racial and ethnic minorities and the elderly with multiple chronic conditions many of whom are currently restricted from accessing telehealth solely by their physical location.
For more details and further statistics on telehealth in Medicare, see the full report.