INTRODUCTION
The COVID-19 pandemic rapidly expanded the use of both audio-only (phone) as well as audio-video (video) remote encounters for Medicare beneficiaries, perhaps prompted by expanded coverage for remote clinician encounters for both telemedicine modalities. 1 The impacts of this expansion of telemedicine on the quality of care received and disparities in access are unknown.1,2 Prior implementation highlights potential barriers which may worsen disparities in access to care, particularly for video encounters.3,4 The Centers for Medicare and Medicaid Services (CMS) commissioned the ‘COVID-19 Fall Supplement’ to the Medicare Current Beneficiary survey (MBCS) in the fall of 2020. We identified predictors of any telemedicine (any phone or video encounter) use as well as for any video or only-phone remote encounters among MCBS respondents to the COVID-19 Fall Supplement (Supplement) administered between October 4th, 2020 and November 15th, 2020 who reported having at least one telemedicine encounter since July 2020.
METHODS
We conducted a cross-sectional analysis of all respondents (N=9,681) to the Supplement, conducted by telephone to continuously enrolled Medicare beneficiaries.5 Our primary variable of interest was whether Medicare beneficiaries completed one or more telemedicine encounters since July 1st, 2020. We fit separate models for any telemedicine as well as any video encounter, or phone encounters only. Beneficiaries responding to ‘both’ audio and video encounters were included in the video encounter total, and the few beneficiaries who were unsure were excluded. Our multivariable regression model included age, gender, race/ethnicity, region of the US, income level, language spoken at home, concurrent Medicaid eligibility and whether respondents were covered by traditional Medicare or Medicare Advantage, all as categorized as in the Supplement.5 Survey responses were adjusted using MCBS sampling weights prior to analysis. All analyses used a significance level of 0.05 and were performed using STATA 16c. This study was determined to not be human subjects research by the Institutional Review Board of the University of California, Los Angeles.
RESULTS
More than half of Medicare beneficiaries had been offered telemedicine by their usual source of care after July 1st 2020 (5,644, 58%), and of those (N = 2,515, 26%) who completed one or more telemedicine encounters, more had completed only phone encounters (1,460, 15%) than a video encounter (1,046, 11%). Medicare beneficiaries utilizing any telemedicine were more likely to be younger than 65 than ages 65 – 75, male, black compared to white, less likely to reside in the Midwest or Northeast compared to the West, and more likely to have access to the internet (Figure 1). Medicare beneficiaries more likely to have a video encounter were younger than 65 or had access to the internet; those less likely were older than age 75, lived in the Midwest, or lived in a non-metropolitan area. Medicare beneficiaries more likely to have a phone telephone encounter were male or black; those less likely lived in the Northeast.
Figure 1:
Characteristics of Medicare beneficiaries utilizing telemedicine after July 1, 2020
DISCUSSION
The expansion of telemedicine reimbursement to include phone encounters and broaden coverage of video encounters has contributed to a rapid expansion of telemedicine for Medicare beneficiaries, where now more than a quarter of a nationally representative sample report having one or more telemedicine encounter since July 2020. Utilization of telemedicine by phone or video are influenced by different characteristics of Medicare beneficiaries. Notably, older and more rural beneficiaries are less likely to have a video encounter, and beneficiaries reporting internet access at home are four times as likely to have a video encounter than those without access to the internet. These differences represent an important opportunity for policymakers to consider what additional training, technology, and technical support will enable Medicare beneficiaries to equally access phone and video telemedicine modalities after the COVID-19 pandemic.
ACKNOWLEDGEMENTS
Dr. Michael Ong is the author of the UpToDate chapters on telemedicine and receives royalties for this authorship, outside the submitted work. There are no other conflicts of interest to report.
REFERENCES:
- 1.CMS. Medicare telemedicine health care provider fact sheet. Centers Medicare Medicaid Serv. 2020;10:1–14. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. [Google Scholar]
- 2.Jacobs EA, Ogedegbe O, Fihn SD. Elective Care and Health Services Research in the COVID-19 Era. JAMA Netw Open. 2020;3(11):e2025731-e2025731. doi: 10.1001/jamanetworkopen.2020.25731 [DOI] [PubMed] [Google Scholar]
- 3.Casillas A, Abhat A, Mahajan A, et al. Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations. J Med Internet Res. 2020;22(10):e16835. doi: 10.2196/16835 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Roberts ET, Mehrotra A. Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine. JAMA Intern Med. 2020;180(10):1386–1389. doi: 10.1001/jamainternmed.2020.2666 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Centers for Medicare & Medicaid Services. 2020 Medicare Current Beneficiary Survey Data User’s Guide: COVID-19 Fall Supplement Public Use File. Retrieved from https://www.cms.gov/files/document/2020mcbscovidpuf-dugfall.pdf, 2021.