About one in six Medicare beneficiaries had at least one telehealth visit between 2021 and 2023, with nearly half of all outpatient visits for mental health conditions delivered virtually, according to a nationally representative analysis.
In teh study, investigators analyzed data from 14,950 adults with self-reported Medicare coverage who participated in the 2021 to 2023 Medical Expenditure Panel Survey. Overall, 16.4% of the beneficiaries had one or more telehealth visits, whereas 83.6% of them had in-person visits only.
Telehealth use was especially common for mental health conditions. Among outpatient visits for mental health diagnoses, 45.1% of them were conducted via telehealth, representing an estimated 31.3 million visits annually. By comparison, 3.3% of outpatient visits for non–mental health conditions were delivered virtually, corresponding to an estimated 29.1 million visits per year.
The most frequent mental health conditions addressed through telehealth were anxiety-related disorders, accounting for an estimated 9.4 million annual visits, followed by depressive disorders at 8.8 million visits. Trauma- and stressor-related disorders and bipolar disorders also ranked among the top conditions managed virtually.
Telehealth also supported care for chronic (eg uncomplicated diabetes mellitus) and acute (eg COVID-19 infections) medical conditions. Among non–mental health diagnoses, uncomplicated diabetes mellitus accounted for an estimated 2.2 million telehealth visits annually, followed by essential hypertension at 1.5 million visits, and COVID-19 infections at 1.1 million visits.
Compared with beneficiaries who used only in-person care, telehealth users were more likely to report fair or poor health (28.9% vs 20.6%), physical or cognitive limitations (59.0% vs 46.7%), and higher number of outpatient visits overall. More than 61% of telehealth users had 14 or more outpatient visits during the study period compared with 34% of nonusers.
Telehealth users also had higher rates of emergency department visits and hospital discharges, suggesting that virtual care was more common among beneficiaries with greater medical complexity.
During the coronavirus disease 2019 public health emergency, the Centers for Medicare and Medicaid Services expanded telehealth coverage for Medicare beneficiaries. However, permanent coverage for non–mental health conditions hasn't been guaranteed.
The investigators noted that withdrawal of telehealth flexibilities could disproportionately affect the most vulnerable Medicare beneficiaries, those with poorer health status and functional limitations who rely on remote care to overcome transportation, mobility, or access barriers.
"Curtailing coverage could reverse recent gains in access and continuity of care, leaving older patients with potentially significant barriers to care if it must be delivered in person," stated lead study author
Terrence Liu, MD, MS, of the Department of Internal Medicine at the University of Utah School of Medicine, and colleagues.
The investigators concluded that telehealth could play a substantial role not only in mental health care, but also in managing chronic and acute medical conditions among Medicare beneficiaries. They emphasized that future policy decisions should consider both access and health system capacity as telehealth coverage continues to evolve, as well as evaluating how this type of coverage might be sustained for the long term.
The study authors reported no conflicts of interest.
Source: Annals of Internal Medicine