While telehealth has been embraced as a silver lining to the pandemic, concerns about phone care (or voice-only telehealth) still haunt its proponents.
Before the pandemic, a federal law wanted Telehealth services are delivered to Medicare beneficiaries via two-way video. However, given the technology challenges Many seniors face management waiver requirement during the COVID-19 public health emergency.
in analysis From traditional Medicare beneficiaries, the Bipartisan Policy Center (BPC) took an in-depth look at the use of voice-only telehealth services.
the findings
We found that use of voice-only telehealth remains high among Medicare beneficiaries, but especially the most vulnerable.
Even as the providers’ offices began reopening at the end of 2021, nearly one in five telehealth visits to Medicare beneficiaries was delivered by phone. Approximately 10% of the recipients had at least one audio visit in the same year. Most importantly, given challenges In the exact coding of voice-only services, these numbers underestimate the amount of voice-only care that is provided.
The BPC analysis showed that vulnerable Medicare beneficiaries — those who were older, disabled and those with multiple chronic conditions — were more likely to rely on voice-only services during the pandemic. Recipients over age 75 and those under age 65 who are eligible for Medicare due to disability were more likely to rely on voice-only services (see bar graph below). We found similar patterns for recipients with five or more chronic conditions, who, compared to those with fewer diagnoses, were disproportionately overrepresented among audio-only users. Beneficiaries were three times more likely to rely on voice-only services for primary care and behavioral health services versus other specialized care.
Breaking down by race and ethnicity, we found that Medicare beneficiaries identified as American Indian or Alaska Native used voice-only services at twice the rate of other Medicare beneficiaries throughout the pandemic. these individuals Most likely to live in Rural and frontier communities in Arizona, Alaska, South Dakota, New Mexico and Oklahoma, and in 2021, at least 40% of telehealth services they received were by phone.
Although the Many believed Voice-only telehealth is a greater benefit for people living in rural areas with barriers to high-speed Internet, and we found that the closer Medicare beneficiaries were to an urban area, the more likely they were to use voice-only services (this same pattern was also true for home visits). bi-directional video). However, audio-only visits were a slightly larger share of all telehealth visits in rural areas.
In addition, our analysis showed that safety net providers provided an increased share of telehealth visits to Medicare beneficiaries from 2020 to 2021 compared to other outpatient providers whose reliance on telehealth remained constant over the same period. This was consistent with Other research that found that safety net providers disproportionately rely on audio-only care, and some health centers were more successful in replacing audio-only visits with video visits over time, despite potentially serving similar groups of patients.
Are there risks to vocal-only care?
While the BPC analysis found that the most vulnerable Medicare beneficiaries use more voice-only care, what is most remarkable is the sustained overall volume of phone visits beyond the peak of the pandemic. This raises a series of questions: Do more people choose phone visits than people who have actual barriers to accessing two-way video? Are provider preferences driving sustained reliance on voice-only care by patients?
Policymakers should proceed with caution with proposals to expand voice-only services for several reasons. The quality of only vocal care, whether delivered alone or as part of a mixed care model, remains untested. Therefore, more research is needed to see whether higher use of audio-only visits among vulnerable Medicare beneficiaries could put certain populations at risk. Low quality care. In fact, auditory flexibility can only theoretically lead to substandard care for people specifically, such as non-friction, and the purpose of accessing the phone is to serve them. As part of a series of qualitative interviews conducted by BPC, providers highlighted their concern about the quality and effectiveness of audio-only visits for new patients.
Increased access to voice-only services also has unknown effects on Medicare spending. Multiple factors contribute to the overall cost of telehealth services, including the rate of reimbursement, the degree to which the service creates new use, the ability of telehealth to replace or replace in-person care, and its impact on patient outcomes and bottom line costs. More research is needed before we can fully understand the impact of voice-only care on health care spending, and if this type of care threatens overuse or Forgery for Medicare.
The long-term acceptance and reimbursement of voice-only services can influence how countries prioritize their broadband investments. Rural Americans, who face disproportionate Communication challenges, most at risk. The 2021 Infrastructure Investments and Jobs Act is included $65 billion for broadband – the largest cash infusion in US history. Decisions about how to strategically invest those dollars now largely remain States. If voice-only telehealth services are permanently opened to all beneficiaries, countries may rethink how they distribute their investments.
If the current policy does not change in the long run, service providers may be less inclined to make the investments necessary to move their entire workflows to two-way video. In addition, some providers may be less inclined to maintain availability for in-person appointments as much as they did pre-pandemic if reimbursement for telehealth remains on par with in-person care.
Navigating the path forward
A few weeks ago, Congress extended the flexibility of Medicare telehealth through the end of 2024. This was welcome news, as extending the flexibility would allow time for a comprehensive assessment of its impact, including a rigorous assessment of voice-only care. Given the insufficient volume of evidence supporting voice-only telehealth, we recommend that use is confined to well-established patient-provider relationships and use outside of primary care and behavioral health services – which is in high demand – be limited to those living either in rural areas. America or have a valid and certified need for telephone visits. Audio-only visits should remain an option for patrons with access barriers who cannot complete two-way video visits — but for those without barriers, the policy should require the use of two-way video.
Although telehealth generally enjoys broad bipartisan support, lingering issues such as how to handle auditory flexibility only delay a permanent policy solution. We hope that our analysis and recommendations will help policymakers to carefully consider the continuing role of voice-only services and strike the right fair balance between access, quality and cost over the long term.
Julia Harris, MPH, MIA, He is the associate director for health at the Bipartisan Policy Center. This work is based on a new BPC report,”The future of telehealth after COVID-19: new opportunities and challenges » and the Medicare fee associated with the service data analysis.