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Early in the pandemic, millions of doctor visits and health care tests were postponed or even canceled to prevent the spread of Covid-19. In many other cases, these normally in-person visits were conducted by phone or video conference instead.
During the outbreak, these telehealth appointments were used. However, there are concerns about the quality of care patients receive and whether telehealth is accessible to everyone.
Today’s Watch blog post looks at how the use of telehealth has grown in Medicaid and Medicare – the government’s health insurance programs. Together, these programs enroll about half of the US population. Medicaid enrolls about 76 million low-income Americans; Medicare provides coverage for about 64 million older Americans and some with disabilities. These two federal programs generally serve individuals of all health conditions and ages.
How has the use of telehealth changed?
Even before the pandemic, Medicaid beneficiaries had the flexibility to use telehealth services in most states. But Medicare beneficiaries did not. By law, Medicare only pays for telehealth services under certain circumstances—for example, in-person services are limited to an area. But the Department of Health and Human Services (HHS), which oversees Medicare during the Covid-19 pandemic, has lifted some of its restrictions. Despite these differences in pre-Covid access, we found significant increases in telehealth use in both programs.
For example, in March We reported. Changes in Telehealth Use Among Medicaid Beneficiaries in Five Selected States. The number of telehealth services in those states increased significantly—15x pre-pandemic levels (from 2.1 million to 32.5 million in the 12 months from March 2020 to February 2021). Learn more about this increase by listening to our podcast with GAO Medicaid expert Carolyn Yocom.
For Medicare, Monday, We have released a new reportTelehealth use in Medicare has increased tenfold from about 5 million services (in April-December 2019) to more than 53 million services in the same months of 2020. billion in those times. Learn more about this increase by listening to our podcast with GAO Medicare expert Leslie Gordon.
How equitable is access to care?
Increasing use of telehealth raises questions about access. For example, the technology used for video health appointments may not be accessible to everyone. from Our previous report, we know that millions of Americans still do not have access to high-speed Internet (broadband). And not everyone has that level of tech savvy.
Also, some healthcare providers, especially those in smaller practices, may not have the technology needed to conduct private and secure video visits. Patients may not be aware of the privacy and security concerns that telehealth technology can pose. We think HHS would do a better job informing patients of these potential issues.
How quality of care can be affected by telehealth.
It may be helpful to visit your doctor via video conference or phone when you can’t be in person. But it has its limitations. For example, doctors may not be able to diagnose problems, observe injuries, or perform physical examinations. We also heard that telehealth may not be right for every patient. for example, We have heard that concern About using telehealth to conduct child health visits. In particular, some officials we interviewed said it may be more difficult to hold the child’s attention during a telehealth visit. During these important tests, it can be very difficult to test the child’s reaction or detect other symptoms. For those suffering from injuries or disabilities, providing effective physical therapy via video can also be difficult.
We looked at how the Centers for Medicare and Medicaid Services (CMS) monitors the quality of care to make sure people enrolled in these programs get the care they need. We got it CMS does not collect, evaluate, or report data on the quality of telehealth care provided by Medicaid providers and recommends that they do so.
CMS has identified concerns with the quality of Medicare telehealth services, including harm to patients and provision of services that are not medically necessary (eg, genetic testing). Despite these concerns, We got it CMS has not taken steps to assess quality of care, nor does it currently have the data to do so.
As a result of our findings, we recommend that CMS better monitor and evaluate how Medicare telehealth services are delivered—especially services provided via audio-only (telephone) service.
The effects of these accessibility issues may further limit the utility of telehealth. To learn more about our work on the use of telehealth Medicaid And MedicareCheck out our latest reports.
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