The U.S. Government Accountability Office is asking the Centers for Medicare and Medicaid Services to gauge the effect that an increase in telehealth utilization is having on the care quality experienced by Medicaid beneficiaries. The GAO cited statistics showing usage continues to rise.
GAO culled data from five states – Arizona, California, Maine, Mississippi and Missouri – and found exponential increases in both the number and percentage of services delivered through telehealth, as well as the number of Medicaid beneficiaries receiving remote care.
For example, from March 2020 through February 2021, 32.5 million services were delivered via telehealth, vs. 2.1 million services the prior year.
The number of Medicaid beneficiaries using the technology is also on the upswing, with 4.9 million beneficiaries in those five states receiving telehealth services over that time, compared to just 455,000 in the 12-month period prior to the COVID-19 pandemic.
The percentage of Medicaid patients receiving at least one service through telehealth increased greatly in all five states, with the greatest increase occurring in Maine: From March 2019 to February 2020, just 2.5% of Maine Medicaid enrollees utilized a telehealth service. From March 2020 to February 2021, that number shot up to 41.8%.
California showed a similar increase (2.5% vs. 41.4%), as did Arizona (11% vs. 43.8%). Mississippi saw the percentage jump from 1.2% to 25.4%, while Missouri saw a jump from 2.3% to %19.9%.
WHAT’S THE IMPACT?
To respond to the COVID-19 pandemic, states have expanded their coverage of telehealth in Medicaid.
The CARES Act includes a provision for GAO to report on the federal response to the pandemic, and the agency was also asked to examine the use of Medicaid flexibilities in response to the pandemic.
GAO analyzed state-reported data on telehealth use in five states, based in part on variation in geography, Medicaid program size and percentage of population living in rural areas. GAO reviewed federal oversight documents, interviewed state and federal Medicaid officials, and assessed CMS’ oversight against its guidance on using data to identify disparities in healthcare and target improvements.
CMS does not collect, assess or report information about any effect delivering services via telehealth has on the quality of care Medicaid beneficiaries receive, and has no plans to do so, GAO said. That’s what it hopes to change.
“It would also be consistent with how CMS has encouraged states to use data on quality of care to identify disparities in healthcare and target opportunities for improvement to advance health equity,” the GAO said.
These efforts could begin with data for quality measures CMS already collects or through other means. CMS has not issued a response to GAO’s recommendations.
THE LARGER TREND
To help beneficiaries maintain access to care amid stay-at-home orders to reduce COVID-19 related exposure, CMS used emergency waiver authorities enacted by Congress, as well as existing regulatory authorities, to implement policies expanding access to telehealth services during the pandemic.
These included waiving several statutory limitations, such as geographic restrictions, and allowing beneficiaries to receive telehealth in their home.
Telehealth utilization increased 63-fold during the pandemic, according to a December 2021 report from the U.S. Department of Health and Human Services. Behavioral health providers saw the highest telehealth utilization, in a 32-fold increase, HHS said.
In 2020, telehealth visits comprised a third of total visits to behavioral health specialists, compared to 8% of visits to primary care providers and 3% of visits to other specialists.
While utilization of telehealth services increased and improved access to services for many beneficiaries, more research is needed to understand the impact on quality of care and why certain beneficiaries used less telehealth than others, HHS said.