With the Medicare temporary telehealth waivers set to expire at the end of this year, Congress continues to work on deciding whether the waivers will be extended, modified or allowed to expire with the current end date. In a new study published by Health Affairs (account or purchase of article required to access), 2022 Medicare fee-for-service claims were examined to determine who would be most impacted by telehealth policy changes.  Titled Telehealth Delivery Differs Significantly By Physician And Practice Characteristics, researchers found that female physicians, primary care physicians (PCP), psychiatrists and physicians in nonrural practices use telehealth more and will likely be most impacted by changes to the current telehealth policy environment for Medicare.
 
Compared to use in other specialties, telehealth was used more by Medicare mental and behavioral health practitioners to deliver services.  The Health Affairs study found that 23% of psychiatrists delivered all or almost all of their services via telehealth. In comparison, the study results revealed that less than 1% of physicians in other specialties used telehealth that much in their practices.
 
The findings regarding a potentially higher impact on psychiatrists if telehealth policies change is likely not surprising to many who have followed telehealth usage in general. Even before the pandemic when more restrictive telehealth policies were in place, telehealth technology was utilized more frequently to provide mental and behavioral health services compared to other specialties. Pre-pandemic telehealth policies were also generally more open to the use of technology in providing mental and behavioral health services. That higher utilization continued during the COVID-19 public health emergency (PHE).  For April 2020, 51% of Medicare telehealth claims were for mental and behavioral health services. (Mulvaney-Day et al, Trends in the Use of Telehealth for Behavioral Health Care During the COVID-19 Pandemic: Considerations for Payers and Employers (Sept 2022)). Midway through the pandemic and afterwards, as things began to open up and in-person services were more readily accessible, telehealth use overall dropped from the highs it saw at the beginning of the PHE.  
 
Interestingly, when looking at other specialties, dermatology, a specialty where telehealth has been employed quite frequently, telehealth was only used in 0.6 percent of the claims compared to 13.1 percent in neurology. While not a part of the study, the dermatology numbers may have been impacted by the more limited policies around asynchronous technology in Medicare.  Dermatologists have been known to largely use asynchronous telehealth and if they were limited to audio or live video, this might have impacted their overall utilization of technology to deliver services.
 
While telehealth has always been promoted as a tool to increasing services to rural communities, with some policies like the permanent telehealth policies in Medicare limiting services to rural regions, the study found that physicians in metropolitan areas accounted for 8.3% of the evaluation and management telehealth visits compared to 5.3% for rural physicians.  The research found this tilt towards urban regions to be consistent throughout specialties. Taking mental and behavioral health as an example, 49% of those telehealth visits took place in metropolitan areas compared to 44% in rural areas. There is the possibility broadband connectivity may play a factor in the edge toward metropolitan areas.
 
Another interesting finding was that female physicians used telehealth more than male physicians. For evaluation and management claims via telehealth, 9% were done by female physicians compared to 6% by male physicians. Additionally, female physicians aged 66 or older provided almost twice their share of visits via telehealth when compared to male physicians aged 20-39 years. The reasons for more female doctors using telehealth needs to be researched further, but some potential factors might be greater family responsibilities and the flexibility telehealth provides in where the provider is located during the time of the interaction.
 
The Centers for Medicare and Medicaid Services (CMS) has already proposed their policies for CY 2025. Some of the proposals do address a few of the temporary policies, but many of the more wide-reaching policies, such as waiving the rural requirement for location of the patient, require Congressional action. Recently, the House Energy and Commerce Committee moved forward HR 7623, the Telehealth Modernization Act of 2024, which would extend the temporary Medicare waivers an additional two years.  The bill will still need to be passed by the House and go through the Senate. This Health Affairs study could help bring more into focus for lawmakers regarding the potential breadth of impacts should the waivers be allowed to expire, be limited, or modified.
 
To read the study in full, you may access it through the Health Affairs website at Telehealth Delivery Differs Significantly By Physician And Practice Characteristics.