Is the telehealth boom set to continue in 2021? Congress and consumers will help decide

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders what they expect to happen to their organization’s telehealth utilization in 2021.

• 31% said “increase.”
• 35% said “decrease.”
• 34% said “no change.”

Among those who expect utilization to increase, respondents cited patient demand and the convenience of telehealth. Those who expect it to decrease in 2021 cited coverage concerns (e.g., they anticipate payers will discontinue current reimbursement levels). They also noted that their patients and/or providers prefer in-person visits, especially as COVID-19 vaccines become available. For respondents expecting no change in 2021, many cited consistent utilization or not having much telehealth utilization in 2020.

The poll was conducted Feb. 9, 2021, with 752 applicable responses.

The regulatory and legislative outlook for Medicare telehealth in 2021 and beyond

Since the beginning of the COVID-19 pandemic, Medicare telehealth usage has soared. These higher utilization rates can be attributed to increased flexibilities stemming from congressional and regulatory action, but most of these flexibilities hinge upon the COVID-19 public health emergency (PHE) remaining in effect.

In January, Acting Secretary of Health and Human Services Norris Cochran stated that the PHE will likely remain in place through 2021 and that the Administration will give states 60 days’ notice before it decides to terminate or let it expire. If true, medical groups should not encounter a “telehealth cliff” this year, in which PHE flexibilities suddenly disappear at the conclusion of the PHE.

The question remains: To what extent will expanded access to Medicare telehealth exist post-PHE? Certain flexibilities, such as the ability to render a telehealth visit to a patient in a rural area or in his or her home, can only be modified by Congress. Over the past year, the benefits of virtual care have caught the attention of lawmakers.

Bipartisan efforts are underway to permanently repeal statutory restrictions that historically served as roadblocks to increased utilization pre-COVID-19. Without more data on costs to the Medicare program and quality outcomes, it will be challenging to make all these waivers permanent. However, Congress has recently made incremental steps in expanding Medicare telehealth by allowing for greater flexibilities for certain services.

The Consolidated Appropriations Act, 2021 would expand mental health services furnished through telehealth following the end of the PHE by waiving geographic and originating site requirements for those services as long as the beneficiary receives at least one in-person mental health service during the six months prior to the first telehealth service.

MGMA will continue to advocate for an extension of these flexibilities past the expiration of the COVID-19 PHE to allow physician practices to continue providing safe, cost-effective virtual care to vulnerable patient populations.

Trends in telehealth utilization

The rapid expansion of telehealth services under the PHE likely means there are few medical groups that have yet to embrace some element of telemedicine. A Dec. 8, 2020, MGMA Stat poll found only 12% of healthcare leaders cited telehealth as something they plan to add in 2021.

New studies on telemedicine during the pandemic are shedding light on how patients drove changes in utilization and what to watch throughout 2021:

• A study of Doctor On Demand data by Harvard Medical School and RAND Corporation suggests that behavioral health issues and chronic conditions were responsible for the largest increases in telehealth utilization during the pandemic. In particular, “[h]igher relative increases were observed for unscheduled behavioral health and chronic illness visits through April … before a decline through the week of June 2.”
• For the growing number of patients experiencing anxiety related to the pandemic, use of teletherapy and on-demand, app-based mental health coaching showed improvement of anxiety disorders, according to a JMIR Formative Research-published study.
• Recent trends in U.S. emergency department (ED) visits show increased utilization for mental health concerns, overdoses and violence, and that strategies to “support telehealth and addiction treatment services” may be useful in lowering ED visits for these patient issues, according to a Centers for Disease Control and Prevention (CDC) study recently published in JAMA Psychiatry.
• Among specialty physicians measured in a recently published study in Health Affairs, endocrinologists, gastroenterologists, neurologists and pain management physicians reported the highest levels of telemedicine use from January to June 2020. That study found that optometry and physical therapy were the least-used specialties for telemedicine in that same period.
• That Health Affairs study also found communities with higher poverty rates reported much lower telehealth utilization.
• Other growth in virtual specialty care was seen in the ability to offer virtual visits, eConsults and navigator services, according to Summus Global, which saw its utilization increase by 3.1 times from January 2020 to January 2021, as reported by Fierce Healthcare.
• The field of tele-neurorehabilitation for stroke victims might be one area in which physical therapists may see utilization grow via new technologies for better outpatient televisits, as reported by Fierce Healthcare.

JOIN MGMA STAT

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/stat. Polls will be sent to your phone via text message. 

ADDITIONAL RESOURCES

• MGMA COVID-19 Recovery Center — Tools, articles, data and other resources to lead your practice through the pandemic.
• “Executive Session: Effective telehealth in pediatrics, OB/GYN to counter future spikes in COVID-19” — Two MGMA-ACMPE Board members — Richard T. Schlosberg IV, MD, FAAP, and William R. “Bill” Hambsh, CPA, FACMPE, discuss their experiences with offering telehealth.

Do you have any best practices or success stories to share on this topic? Please let us know by emailing us at connection@mgma.com.

This poll was conducted in collaboration with Change Healthcare.