Researchers exploring changes in telemedicine use during the pandemic expected to find access to visits disproportionately benefiting some communities but not others. Instead, they were surprised to discover, virtual care reached patients in even the most disadvantaged neighborhoods.
“We were relieved to find that the rapid increase in telemedicine use…was not associated with worsening disparities,” wrote Sanuja Bose and Caitlin Hicks, two of the study’s co-authors, in a newsletter accompanying the May issue of Health Affairs.
Their analysis, which reflects 100% of Medicare fee-for-service claims, included nearly 30 million claims from January 2019 to March 2021. That period straddles the March 6, 2020, Medicare telemedicine coverage waiver, which authorized Medicare to pay for telehealth visits at the same rate as in-person ones on an emergency basis.
A sharp increase in use was seen starting that month. When socioeconomic disadvantage was factored in, researchers found no significant differences between people residing in the most versus the least disadvantaged neighborhoods in terms of which ones had received at least one outpatient visit. In fact, the highest odds of utilization were observed among people residing in the most disadvantaged neighborhoods.
“After adjustment, our data suggest that the coverage waiver increased access to telemedicine for all Medicare populations,” the study authors noted. They called the characteristics of the populations assessed “our most meaningful finding.”
The results may lay to rest fears, which had festered during the pandemic, that broadening telemedicine coverage nationally might serve to worsen preexisting health disparities. For instance, some studies have found that telemedicine use was lower in communities with higher rates of poverty, when commercially insured and Medicare Advantage enrollees are taken into account.
“Critics of the waiver suggested that expanding the scope of telemedicine would only improve healthcare access for the most fortunate – those with the best Internet and up-to-date smartphones – while others were left behind,” explained Bose and Hicks, a master’s student at Johns Hopkins Bloomberg School of Public Health and an associate professor at Johns Hopkins University School of Medicine, respectively.
“In fact, patients living in the most disadvantaged neighborhoods experienced the greatest net increase in telemedicine use relative to their counterparts living in the least disadvantaged neighborhoods,” they wrote.
The study authors are in favor of extending broad telemedicine coverage — which is to say, not just reauthorizing the emergency waiver, due to expire on July 15. They argued that their analysis supports virtual visits becoming part of the new normal.
“By reducing fears that the waiver has worsened disparities in healthcare access, we hope our study provides motivation to advocate for continued telemedicine coverage beyond the nationwide public health emergency,” they wrote.
The only population not to see a dramatic increase in the telemedicine study was the elderly. That’s a population that could benefit from targeted interventions, the researchers suggested.