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Less Than 8% of Medicare Beneficiaries Had Disruption in Care Due to COVID-19
In this Q&A, Associate Professor at the University of North Florida in Jacksonville, Hanadi (Hana) Hamadi, PhD, discusses her recent study "Medicare and telehealth: the impact of COVID-19 pandemic." She explores the impetus for the study, the key findings and their practical clinical applications, and the future of telehealth. The study was published in the Journal of Evaluation in Clinical Practice.
Question: What led you and your co-authors to investigate telehealth utilization patterns of Medicare beneficiaries during the height of the pandemic?
Answer: The pandemic has resulted in major capacity issues for many local health systems. The need for medical services for individuals 65 [years and older] continued to stay the same and a gap in care was becoming evident. We wanted to understand not only the telehealth services being provided by providers but also the ability for individuals who need the care to access it. This will allow us to provide policymakers relevant information about future decisions on telehealth reimbursement for Medicare.
Prior research has shown that telehealth utilization among individuals [over 65 years old] can be limited by user-interface barriers, access to internet, or even ability to connect with providers digitally.
Q: Can you briefly describe your study methods and key findings?
A: We used the Centers for Medicare and Medicaid Services (CMS) Medicare Current Beneficiary Survey Fall 2020 COVID-19 Supplement the was recently made available to gain an understanding of telehealth patterns among Medicare providers and Medicare beneficiaries’ abilities to utilize these services.
We used a series of multiple logistic regression to examine the relationship between telehealth offering and beneficiaries' sociodemographic variables for 9686 Medicare beneficiaries. Over half (58%) of primary care providers provided telehealth services, while only 26%–28% of specialists did.
Less than 8% of Medicare beneficiaries reported that they were unable to obtain care because of COVID-19. Lack of resources, internet access, and availability of medical services all contribute to the variance in telehealth use.
Q: Were there any findings that were surprising or different than expected?
A: The findings were not surprising from the provider side. We expected an increase in telehealth offerings by providers. Our survey confirmed that patients under 75 [years old] generally were greater utilizers of telehealth services.
What was surprising the level of engagement and use of such services by the Medicare population. We found that less than 8% of Medicare beneficiaries had disruption in care.
Q: What are the practical implications of your findings for clinicians utilizing telehealth?
A:
For Clinicians:
- Medicare beneficiaries were provided with an important and emerging access point to the health care system as in-person visits were being discouraged or were unavailable due to the risks of the COVID-19 virus.
- These services (if policymakers can regulate reimbursement) are vital to ensure (a) Continuity of care and (b) Access to care otherwise unavailable.
- Telehealth has been utilized in mental Health services to fill a much needed shortage gap, and I can translate with the current technology to other specialties.
Q: The study dives into policy recommendations since telehealth “encouraged access to care.” What do you hope policymakers implement after reading and learning from your study?
A:
Policymakers must:
- Ascertain which elements of the new telehealth landscape will be retained
- Modernize the regulatory, accreditation and reimbursement framework to maintain pace with care model innovation
- Address disparities in access to broadband connectivity with a particular focus on rural and underserved communities
Q: Where do you see the future of telehealth going in the post-COVID-19 world?
A: As a population, we are users of technology in everything we do, from banking to entertainment. This change has slowly occurred over the last 10 years. The seamless interaction of such technologies in everyday life, has opened the door for its acceptance in medical services among this population of Medicare beneficiaries. This population will integrate with using these telehealth services and acceptance will continue to grow.
Q: Is there anything else you would like to add?
A: One of the main reasons telehealth services were not reimbursed by Medicare services for a wide range of services was due to fear of fraud. Furthermore, there was a great push on the idea that this population needed the interaction with providers (physically) for trust to be built and quality care to be provided. These messages have not held true during COVID-19 or at least there was a great incentive to accept telehealth as a viable option. We will continue to have a hybrid health care system for a long time to come.
Hanadi (Hana) Hamadi, PhD, is an associate professor in the Department of Health Administration at the University of North Florida, Jacksonville. She earned her PhD from the University of South Carolina. Dr Hamadi’s research focuses on health services and systems of care for vulnerable populations. Her research agenda focuses on the evaluation of health outcome initiatives (HOIs), with an emphasis on cost-effectiveness and policy impact of social determinants. She is currently focused on exploring the relationships between people, communities, and health systems. She is also involved public health systems and services research investigating state-by-state Medicaid related policies and their impact on reimbursement, physician behavior, and cost-containment efforts. In addition to selected research projects, Dr Hamadi is also focused on the evaluation of quality interventions and influences of federal/state policies on health outcomes.
