Medicare Beneficiaries in Disadvantaged Areas Used Telemedicine More During Pandemic

People living in the most disadvantaged neighborhoods in the United States had greater odds of using telemedicine than those living in the least disadvantaged neighborhoods after CMS expanded coverage to all Medicare beneficiaries in 2020, findings showed.

“Telemedicine is one means by which access to health care may be improved,” study authors said. “The utility of telemedicine has become particularly evident during the COVID-19 pandemic, as remote consulting and triaging allow patients to maintain adequate physical distancing and avoid overburdening hospitals.”

CMS expanded telemedicine coverage to all Medicare beneficiaries on March 6, 2020. The retrospective cohort study was conducted using Medicare fee-for-service claims data for adult patients who had at least 1 outpatient visit from January 2019 through March 2021.

Before coverage was expanded, .42% of patients had at least 1 telemedicine visit (129,114 out of 30,488,891 total patients). By contrast, 9.97% of patients had at least 1 telemedicine appointment after the expansion (2,795,242 out of 28,038,684 total patients, P<.001).

Researchers used the area deprivation index (ADI) to determine the socioeconomic status of patients. The ADI includes “household income, education, employment, and housing quality at the census block group level to provide a more holistic assessment of geographical socioeconomic disadvantage than individual socioeconomic status markers can provide,” authors noted.

In the week following the coverage expansion, telemedicine use increased 56-fold in the least disadvantaged neighborhoods (95% CI: 12.3, 253.7, P<.001) vs 28.9-fold in the most disadvantaged neighborhoods (95% CI: 10.4, 79.9, P<.001).

While studying the association between patient characteristics and telemedicine use, researchers adjusted for demographic variables, comorbidities, and region and residency factors.

Before the waiver was implemented, people living in the most and least disadvantaged areas had similar odds of using telemedicine (ADI-4 vs ADI-1, OR: .97; 95% CI: .94, 1.01). Increasing age and Black race were linked to lower odds of utilization, and higher odds were associated with female sex, increasing Charlson Comorbidity index score, and rural location.

By contrast, after the waiver was implemented, “increasing ADI quartile was persistently associated with higher odds of telemedicine use,” researchers said. People living in the most disadvantaged areas had the highest odds of using telemedicine, compared to those living in the least disadvantaged neighborhoods (ADI-4 vs ADI-1, OR: 1.14; 95% CI: 1.12, 1.15).

Odds of using telemedicine were lower with increasing age and rural location in the postwaiver period. Higher odds were associated with female sex, Asian and Hispanic race and ethnicity, and increasing Charlson Comorbidity Index score.

“Overall, our data suggest large swings in access to telemedicine across the United States for all populations, including people living in the most disadvantaged neighborhoods,” authors said.

“The correlation shown by our data suggests that CMS was, in fact, successful in reaching even people in the most disadvantaged US neighborhoods with its telemedicine coverage waiver, at least among Medicare beneficiaries.”

Reference:
Bose S, Dun C, Zhang GQ, Walsh C, Makary MA, Hicks CW. Medicare beneficiaries in disadvantaged neighborhoods increased telemedicine use during the COVID-19 pandemic. Health Aff. 2022;41(5). doi:10.1377/hlthaff.2021.01706