Telehealth Was Critical for Providing Services to Medicare
Beneficiaries During the First Year of the COVID-19 Pandemic

Why OIG Did This Review
The COVID-19 pandemic created unprecedented challenges for how
Medicare beneficiaries accessed health care. In response, the

Key Takeaways

o Over 28 million Medicare

beneficiaries used
telehealth during the first
year of the pandemic. This
was more than 2 in 5
Medicare beneficiaries.

Beneficiaries used 88 times
more telehealth services
during the first year of the
pandemic than they used in
the prior year.

sXlaiK@l lla SMU MOLE
telehealth peaked at the

Department of Health and Human Services (HHS) and the Centers for
Medicare & Medicaid Services (CMS) took a number of actions to
temporarily expand access to telehealth for Medicare beneficiaries. '
CMS allowed beneficiaries to use telehealth for a wide range of
services; it also allowed beneficiaries to use telehealth in different
locations, including in urban areas and from the beneficiary's home.

Understanding the use of telehealth during the first year of the
pandemic can shed light on how the temporary expansion of
telehealth affected where and how beneficiaries accessed their health
care. This information can help CMS, Congress, and other stakeholders
make decisions about how telehealth can be best used to meet the
needs of beneficiaries in the future.

beginning of the pandemic
and remained high through

This data brief provides insight into the use of telehealth in both
early 2021.

Medicare fee-for-service and Medicare Advantage during the first year
of the COVID-19 pandemic. It is a companion to a report that
examines the characteristics of beneficiaries who used telehealth
during the pandemic." Another report in this series identifies program
integrity concerns related to telehealth during the pandemic.?

Beneficiaries most
commonly used telehealth
for office visits during the
first year of the pandemic.

 

How OIG Did This Review

We based this analysis on Medicare fee-for-service claims data and Medicare Advantage encounter
data from March 1, 2020, to February 28, 2021, and from the prior year, March 1, 2019, to February
29, 2020. We used these data to determine the total number of services used via telehealth and in-
person, as well as the types of services used. We also compared the number of services used via
telehealth and in-person during the first year of the pandemic to those used in the prior year.

What OIG Found

Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was
more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services
during the first year of the pandemic than they used in the prior year. Beneficiaries' use of telehealth
peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to
receive 12 percent of their services during the first year of the pandemic. Beneficiaries most commonly
used telehealth for office visits, which accounted for just under half of all telenealth services used during
the first year of the pandemic. However, beneficiaries' use of telehealth for behavioral health services
stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared
to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of
behavioral health services, whereas they used telehealth for 13 percent of office visits.

What OIG Concludes

Telehealth was critical for providing services to Medicare beneficiaries during the first year of the
pandemic. Beneficiaries' use of telehealth during the pandemic also demonstrates the long-term
potential of telehealth to increase access to health care for beneficiaries. Further, it shows that
beneficiaries particularly benefited from the ability to use telehealth for certain services, such as
behavioral health services. These findings are important for CMS, Congress, and other stakeholders to
take into account as they consider making changes to telehealth in Medicare. For example, CMS could
use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.
Primer on:

refer to services that are provided remotely using
technology between a provider and a beneficiary.

During the pandemic, CMS allowed beneficiaries to use telehealth to access a
wide range of services in different locations, including in

. Prior to the pandemic, beneficiaries were allowed to
use telehealth only from medical facilities located in rural areas, with a few
exceptions.*

During the pandemic, CMS increased the types of services that beneficiaries
could use via telehealth, from 118 to >

The services that can be provided via telehealth include '
' , and , among
others. Most of these services can also be provided in person.

A group of telehealth services known as are
© An example of these services includes a telephone call
with a provider to discuss a beneficiary's medical condition.

During the pandemic, CMS expanded the use of for certain types of
telehealth services, such as office visits and behavioral health services. Prior to
the pandemic, only audio-video was allowed for the delivery of telehealth
services, with a few exceptions.'

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic

OEI-02-20-00520

aalantsia

 
RESULTS

 

The COVID-19 pandemic created disruptions in how Medicare beneficiaries accessed
health care. Because of concerns about the pandemic, HHS and CMS took a number
of actions to provide broader access to telehealth for Medicare beneficiaries. CMS
allowed beneficiaries to use telehealth for a wide range of services; it also allowed
beneficiaries to use telehealth in different locations, including in urban areas and
from the beneficiary's home.

This data brief examines the use of telehealth services from March 2020 through
February 2021. It also looks at the growth of telehealth services, the extent to which
beneficiaries also used in-person services, and the types of telehealth services most
commonly used. It includes beneficiaries in Medicare fee-for-service and in Medicare
Advantage.

Understanding the use of telehealth during this time can shed light on how the
temporary expansion of telehealth affected where and how beneficiaries accessed
their health care. This information can help CMS, Congress, and other stakeholders
make decisions about how telehealth can be best used to meet the needs of
beneficiaries in the future.

Over 28 million Medicare beneficiaries used telehealth during
the first year of the pandemic

More than 28 million Medicare beneficiaries used a telehealth service during the first
year of the pandemic-from March 2020
through February 2021. These beneficiaries
represented 43 percent of the 66 million
beneficiaries enrolled in Medicare, or about
2 in 5 Medicare beneficiaries.

This is a dramatic increase from the prior year,
when less than 1 percent of Medicare
beneficiaries-approximately 341,000 in
total-used telehealth.

More than 2 in 5 Medicare
beneficiaries used telehealth
during the first year of the pandemic

During the first year of the pandemic, more than half of beneficiaries (55 percent) who
used telehealth used only 1 to 2 services, while the remainder used 3 or more
telehealth services. Further, almost all beneficiaries who used telehealth during the
first year of the pandemic also used in-person services.

In addition, 84 percent of beneficiaries who used telehealth during the pandemic
received telehealth services only from providers with whom they had an established

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Results | 4
relationship.® These beneficiaries received an in-person service from a provider an
average of 4 months prior to their first telehealth service.

Overall, beneficiaries enrolled in Medicare Advantage were more likely to use
telehealth than those in Medicare fee-for-service. In total, 49 percent of beneficiaries
enrolled in Medicare Advantage used telehealth, compared to 38 percent of those
enrolled in Medicare fee-for-service. Prior to the pandemic, Medicare Advantage had
greater flexibility to provide telehealth services to beneficiaries.*

Beneficiaries used 88 times more telehealth services during the
first year of the pandemic than they used in the prior year

Medicare beneficiaries used 114.4 million telehealth services from March 2020
through February 2021. This amounts to 88 times more telehealth services compared
to the year prior to the pandemic,
when beneficiaries used 1.3 Medicare paid over $5.1 billion for
million telehealth services. telehealth services for beneficiaries enrolled

in Medicare fee-for-service during the first

Over half of these telehealth year of the pandemic.

services (60.1 million in total) were

used by beneficiaries enrolled in Medicare fee-for-service. In total, Medicare paid
over $5.1 billion for these services, 76 times more than what it paid for telehealth in
the prior year."

CMS's temporary policy changes enabled the monumental growth in the use of
telehealth in multiple ways. CMS allowed beneficiaries to use telehealth services from
home and from any geographic location, including urban areas, beginning in March
2020."' In addition, CMS temporarily expanded the types of services that could be
provided via telehealth. Specifically, CMS allowed for 264 services to be provided via
telehealth during the pandemic, compared to 118 services prior to the pandemic.

Beneficiaries' use of telehealth peaked at the beginning of the
pandemic and remained high through early 2021

Telehealth use peaked in the early months of the pandemic. At the height of
telehealth use in April 2020, beneficiaries used 17.6 million telehealth services,
followed by 13.6 million telehealth services in May 2020. In these early months, some
States and localities had issued stay-at-home orders and some health care providers
suspended in-person care because of increasing COVID-19 infection rates.

From June through November 2020, the number of telehealth services steadily
decreased to 7.8 million services in November. In December 2020, telehealth services
increased slightly, before declining again in February 2021. Despite the decline, the
number of telehealth services in February 2021 was almost twice as high as in

March 2020. See Exhibit 1.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Results | 5
Exhibit 1: Beneficiaries' use of telehealth peaked in April 2020, decreased
through the late spring, summer, and fall, and briefly increased again in
December 2020.

Peaked at 17.6 million
in April 2020

 

Beneficiaries used nearly 2 times
the number of telehealth services
in February 2021 as in March 2020

Source: OG analysis of CMS data, 2022.

Even though telehealth use increased dramatically, beneficiaries
still received most of their care in-person

Even though the use of telehealth increased substantially during the pandemic,
telehealth accounted for 12 percent of all services used by beneficiaries during the
first year of the pandemic."

However, not all months were the same. At the peak of telehealth use in April 2020,
telehealth accounted for 29 percent of all services. In most other months,
beneficiaries used telehealth for 9 to 11 percent of all services. See Exhibit 2.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic
OEI-02-20-00520 Results | 6
Exhibit 2: At telehealth's peak, beneficiaries used it for 29 percent of all services.

11% 10%

Source: O1G analysis. of CMS data, 2022,

9% 8%

: ee oe
eS ee

In Person

11% | 10% 10%

BE Teercain

Despite the significant increase in telehealth, beneficiaries used
fewer services overall during the first year of the pandemic than

they did in the prior year

Despite a large increase in the use of telehealth, beneficiaries used fewer services

overall during the first year of the
pandemic than they did in the prior year.
Beneficiaries' use of telehealth only
partially filled the gap left by a decrease
in in-person services during the
pandemic.

In total, beneficiaries used 20 percent
fewer services, amounting to 990 million
services during the pandemic, down from
1.2 billion services the year prior. See
Exhibit 3. The decrease in services is
likely because of some health care
providers temporarily suspending in-
person care, beneficiaries forgoing care
because of concerns about community
spread of COVID-19, and the strain on
providers to offer needed services related
to COVID-19, among other factors. ?

Exhibit 3: Beneficiaries used 20 percent
fewer services during the first year of the
pandemic than in the prior year.

1.2 Billion
990 Million
12%

<1% Telehealth

Telehealth

Source: OG analysis of CMS data, 2022,

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic

OEI-02-20-00520 Results | 7
Beneficiaries most commonly used telehealth for office visits
during the first year of the pandemic

From March 2020 through February 2021, beneficiaries most commonly used
telehealth for office visits, virtual care services, behavioral health services, nursing
home visits, and preventive services. Beneficiaries also used telehealth for a wide
variety of other services. See Appendices A and B for more information about these
services and the extent to which beneficiaries used telehealth for these services.

54.5 million
Office visits

34 million
Virtual care
services

=x
an

14.1 million
Behavioral
health
services

 

During the first year of the pandemic, beneficiaries most often used
telehealth for office visits. These are routine appointments with a
primary care provider or specialist. In total, beneficiaries received
54.5 million office visits via telehealth. These office visits accounted
for just under half (48 percent) of all telehealth services used during
the first year of the pandemic. This percentage was similar for
beneficiaries in Medicare fee-for-service and Medicare Advantage.

Next, beneficiaries most commonly used telehealth for virtual care
services, totaling 34 million of these services during the first year of
the pandemic. These services, unlike most Medicare telehealth
services, can only be provided remotely. The most common type of
virtual care service is a telephone call with a provider to discuss a
beneficiary's medical condition, referred to as a telephone evaluation
and management service. Beneficiaries used over 28 million of these
services, accounting for a quarter of all telehealth services used
during the first year of the pandemic.

Other common virtual care services include discussions with a
provider of up to 10 minutes, known as virtual check-ins." Virtual
care services also include online interactions via a patient portal,
known as e-visits, and remote monitoring of a beneficiary's weight
or other vital statistics. Beneficiaries in Medicare Advantage used
more virtual care services than beneficiaries in Medicare fee-for-
service, with these services accounting for 35 percent of all
telehealth services in Medicare Advantage, compared to 25 percent
in Medicare fee-for-service.

Beneficiaries also commonly used telehealth for behavioral health
services, totaling 14.1 million services. Behavioral health services
include individual therapy, group therapy, and substance use
disorder treatment, among others. Beneficiaries in Medicare fee-for-
service used more behavioral health services than those in Medicare
Advantage, with these services accounting for 16 percent of all
telehealth services in Medicare fee-for-service, compared to

9 percent in Medicare Advantage.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic
OEI-02-20-00520

Results | 8
Nursing home visits were the next most common telehealth service,

3.3 million . a "i
Nursi with beneficiaries using 3.3 million services during the first year of
ursing . ag «tgs
. the pandemic. Nursing home visits include initial and subsequent
home visits

visits from a provider with a beneficiary located in a nursing home
~~ that are conducted via telehealth. These visits include discussions
Ee between a provider and beneficiary regarding a beneficiary's medical
condition, and nursing home discharge management services,
among others. Nursing home visits were slightly more common
among beneficiaries in Medicare fee-for-service (4 percent of
services) than those in Medicare Advantage (2 percent of services).

Beneficiaries also commonly used telehealth for preventive services,

2.4 million m " ;
. totaling 2.4 million of these services during the first year of the
Preventive . . . .
services pandemic. Preventive services include annual wellness visits,

diabetes management training, medical nutrition therapy, and
tobacco use counseling. There was no difference in the use of these
telehealth services between beneficiaries in Medicare fee-for-service
and Medicare Advantage.

 

Beneficiaries' use of telehealth for behavioral health services
stands out

While beneficiaries used telehealth for a number of different services, beneficiaries'
use of telehealth for behavioral health services stands out. Beneficiaries used
telehealth for a larger share of their behavioral health services compared to their use
of telehealth for other services. Specifically, beneficiaries used telehealth for

43 percent of all behavioral health services they received during the first year of the
pandemic. In contrast, they used telehealth for only 13 percent of all office visits they
received during the first year of the pandemic. See Exhibit 4 and Appendix C.

Understanding which services beneficiaries use telehealth for, compared to their use
of these services in-person, helps inform questions about how beneficiaries access
their health care. In particular, beneficiaries' use of telehealth for behavioral health
services relative to their use of these services in-person shows that beneficiaries
benefited from the ability to use telehealth for these services. This is further
supported by literature prior to the pandemic that suggests the use of telehealth for
behavioral health may improve access, especially for beneficiaries facing barriers to
care."

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Results | 9
Exhibit 4: Beneficiaries used telehealth for a larger share of their behavioral
health services compared to other services.

Behavioral Health kta 57%

Office Visits iA 87%

Preventive Services [ERA 91%

Nursing Home Visits [Bix 92%

@ Telehealth In-Person

Source: OIG analysis of CMS data, 2022.
Note: Virtual care services are not included as they are provided exclusively via telehealth.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Results | 10
CONCLUSION

 

The COVID-19 pandemic created unprecedented challenges for how Medicare
beneficiaries accessed health care. In response, HHS and CMS took a number of
actions to temporarily expand access to telehealth for Medicare beneficiaries.

Beneficiaries' use of telehealth increased dramatically during the first year of the
pandemic. Over 28 million-more than 2 in 5-Medicare beneficiaries used
telehealth services during the first year of the pandemic, from March 2020 through
February 2021. In total, beneficiaries used 88 times more telehealth services during
the first year of the pandemic than they did in the prior year. Beneficiaries' use of
telehealth was particularly high in April 2020, when it accounted for 29 percent of all
services. It then decreased to around 10 percent of services per month-still almost
twice the level it was in March 2020.

In addition, beneficiaries most commonly used telehealth for office visits, but their use
of telehealth for behavioral health services stands out. Beneficiaries used telehealth
for a larger share of their behavioral health services compared to their use of
telehealth for other services.

Telehealth was critical for providing services to Medicare beneficiaries during the first
year of the pandemic. Beneficiaries' use of telehealth during the pandemic also
demonstrates the long-term potential of telehealth to increase access to health care
for beneficiaries. Further, it shows that beneficiaries particularly benefited from the
ability to use telehealth for certain services, such as behavioral health services. These
findings are important for CMS, Congress, and other stakeholders to take into
account as they consider making changes to telehealth in Medicare.'® For example,
CMS could use these findings to inform changes to the services that are allowed via
telehealth on a permanent basis.

These changes to telehealth need to balance concerns about access, quality of care,
equity, and program integrity so that the benefits of telehealth are realized, and
Medicare can best meet the needs of its beneficiaries. OIG has additional evaluations
and audits underway examining telehealth in Medicare to help further inform
program policies and oversight.""

Conclusion | 11
METHODOLOGY

 

We based this data brief on an analysis of Medicare fee-for-service claims and
Medicare Advantage encounters for telehealth services from March 1, 2020, to
February 28, 2021. These data are similar to the data used in other reports in the
series about Medicare beneficiaries' use of telehealth during the first year of the
pandemic. '®

We used the Medicare fee-for-service claims from the National Claims History File
and Medicare Advantage encounters from Part C Encounter data. We also used
enrollment data for Medicare fee-for-service and Medicare Advantage from the
Medicare Enrollment Database.

Beneficiaries' Use of Telehealth Services

To conduct this analysis, we first identified the services that Medicare approved for
telehealth during the pandemic.'? These services are described using Current
Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding
System (HCPCS) codes. These codes are included on the claim by a provider for
reimbursement purposes.

As part of our analysis, we included virtual care services as a type of telehealth service.
These services are also referred to as Communication Technology-Based Services.
These services are always provided remotely, and include virtual check-ins, e-visits,
remote monitoring, and telephone calls with a provider to discuss a beneficiary's
medical condition.

We identified the services that were provided via telehealth using a modifier (i.e., 95,
GT, GQ, or GO) or a "place of service code" (i.e., 02) that indicates the service was
delivered via telehealth. We considered the services that did not have these modifiers
or codes to be delivered in-person."

Using these data, we determined the number of beneficiaries who used telehealth
services during the first year of the pandemic, from March 2020 through February
2021. We included beneficiaries who had at least one Medicare fee-for-service claim
or Medicare Advantage encounter for a telehealth service during the first year of the
pandemic.

Next, we calculated the percentage of beneficiaries enrolled in Medicare fee-for-
service or Medicare Advantage who used telehealth. We determined the number of
beneficiaries enrolled in each program based on Medicare enrollment data.""

Methodology | 12
We also calculated the number of services each beneficiary used during the first year
of the pandemic.

Use of Telehealth and In-Person Services

Using both Medicare fee-for-service claims data and Medicare Advantage encounters,
we determined the extent to which the use of telehealth services changed during the
first year of the pandemic. We calculated the number of telehealth services
beneficiaries used in each month, as well as the total number of telehealth services
used.

We also calculated the total amount paid by Medicare for telehealth services during
the first year of the pandemic and compared that amount to the total Medicare
payments for telehealth services in the prior year. Payment amounts are for
beneficiaries in Medicare fee-for-service only; payment amounts are unavailable in the
Medicare Advantage encounters.

We also calculated the number of in-person services used during the first year of the
pandemic and compared this to the number of telehealth services provided. We then
compared the total number of services used during the first year of the pandemic to
the total number of services used in the prior year.

Most Common Telehealth Services

We grouped each service into a category based on CMSs service classification system
and CPT codes.*? To determine the most common services that beneficiaries used via
telehealth, we calculated the number of telehealth services in each category. We also
calculated the proportion of the services in each category that were provided via
telehealth and in-person.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic
OEI-02-20-00520

Methodology | 13
APPENDIX A

 

Examples of Medicare services that can be provided via telehealth

Se PS ot

 
 
   
      
     
   

Virtual Care Services

  

  

Office Visits Behavioral Health Nursing Home Visits
Routine appointment Telephone call to Services Visit from a provider
with a primary care discuss a beneficiary's Individual therapy with a beneficiary
provider or specialist medical condition Group therapy located ina nursing

sb ae aa ate : . home

Online interactions via agin seuss is

a patient portal ee Pe aeomer Remote assistance with

Remote monitoring of the use of a ventilator

   

 

   
   
 
   
 
   
   
  
  

   
   
 
       
   
   
 

 
  
   
 
   

  
   
    
   
 
 
  

  
   
   
  
  
  
   
 

vital statistics

Annual wellness visit Occupational, and - Visit from a spider Hospital observation ar
Speech Therapy Visits ith 2 benefi - - i

Diabetes management : Mi 8 iclary Inpatient care:

training Vee nt located ot bea: Emergency department
anaigerie Evaluation of ventilator visit

Medical nutrition

  

thers Training in use of use for a beneficiary species
e prosthesis: receiving respiratory posicalatieri

Tobacco use: Falls f h care at home

counseling eee

fluency

 

 

Assisted Living Visits Transitional Care Dialysis Services - Advance Care

Visit from a provider Services End- -stage renal Planning Services
with a beneficiary Communication with disease related Explanation and
located in an assisted beneficiary or caregiver services, such as: discussion of advance

living facility after discharge from
hospital

monitoring of nutrition directives with a
and counseling beneficiary and/or
family member

    

Ophthalmology Other Services
Services Radiation treatment
Eye examination and management

evaluation.

Evaluation of inhaler use

 

"en het

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Appendix A | 14
APPENDIX B

 

Beneficiaries most commonly used telehealth for office visits, virtual care
services, and behavioral health services during the first year of the pandemic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Visits 54,463,209 47.6%
Virtual Care Services 34,060,592 29.8%
Telephone Evaluation & Management 28,635,904 25.0%
Virtual Check-ins & E-Visits 3,324,710 2.9%
Remote Patient Monitoring 2,099,978 1.8%
Behavioral Health 14,152,781 12.4%
Nursing Home Visits 3,282,129 2.9%
Preventive Services 2,421,535 2.1%
Physical, Occupational, and Speech
Therapy 2,068,650 1.8%
Home Visits 1,312,412 1.1%
Hospital Visits 987,794 0.9%
Assisted Living Visits 742,825 0.6%
Transitional Care Services 336,057 0.3%
Dialysis Services 297,669 0.3%
Advance Care Planning Services 203,950 0.2%
Ophthalmology Services 22,/39 0.0%
Other Services 25,728 0.0%
Total 114,378,070 100.0%

Source: OIG analysis of CMS data, 2022.
Note: The subcategories of virtual care services are not included in calculating the total number of
services and percentage.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Appendix B | 15
APPENDIX C

 

Beneficiaries used telehealth to receive a larger share of their behavioral health
services compared to their use of telehealth for other services during the first

year of the pandemic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Behavioral Health 43% 57% 14,152,781 19,032,147
Home Visits 17% 83% 1,312,412 6,611,694
Transitional Care Services 16% 84% 336,057 1,791,001
Office Visits. 13% 87% 54,463,209 369,428,178
Assisted Living Visits 11% 89%. 742,825, 5,783,624
Preventive Services 9% 91% (2,421,535. 25,717,146
Nursing Home Visits 8% 92% 3,282,129 37,577,388
Advance Care P fanning .

Services 6% 94% 203,950 3,268,698
Dialysis Services 5% 95% 297,669 5,321,451
Physical, Occupational, and . . .

Speech Therapy 1% 99% 2,068,650 154,679,811
Other Services 1% 99% 25,728 2,672,621
Hospital Visits. 0% 100% 987,794 211,243,352
Ophthalmology Services 0% 100%. 22,739 32,892,849
Total 8% 92% 80,317,478 876,019,960

'Source: OIG analysis of CMS data, 2022.

Note: Virtual care services are not included in this tableas they are provided exclusively via telehealth.
They account for 34,060,592 telehealth services.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic
OEI-02-20-00520

Appendix C | 16
ACKNOWLEDGMENTS AND CONTACT

 

Acknowledgments

Vincent Greiber served as the team leader for this study. Others in the Office of
Evaluation and Inspections who conducted the study include John Gordon and

Aaron Plotke. Office of Evaluation and Inspections staff who provided support include
Robert Gibbons and Michael Novello.

This report was prepared under the direction of Jodi Nudelman, Regional Inspector
General for Evaluation and Inspections in the New York regional office, and
Nancy Harrison and Meridith Seife, Deputy Regional Inspectors General.

Contact

To obtain additional information concerning this report, contact the Office of Public
Affairs at Public.Affairs@oig.hhs.gov. OIG reports and other information can be found
on the OIG website at oig.hhs.gov.

Office of Inspector General

U.S. Department of Health and Human Services
330 Independence Avenue, SW

Washington, DC 20201

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19

Pandemic
OEI-02-20-00520

Acknowledgments and Contact | 17
ENDNOTES

 

' HHS and CMS were able to expand the use of telehealth as a result of the declaration of a Public Health Emergency (PHE) and
subsequent legislation, among other actions. The PHE was announced on January 31, 2020 and was retroactively effective to
January 27, 2020. The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 and the CARES Act
allowed CMS to waive telehealth-related restrictions with a PHE declaration in place. See Coronavirus Preparedness and
Response Supplemental Appropriations Act of 2020, accessed at Text - H.R.6074 - 116th Congress (2019-2020): Coronavirus
Preparedness and Response Supplemental Appropriations Act, 2020 | Conaress.gov | Library of Congress on November 23,
2021. See also, CARES Act, accessed at Text - H.R.748 - 116th Congress (2019-2020): CARES Act | Congress.gov | Library of
Congress on November 23, 2021.

2 OIG, Certain Medicare Beneficiaries Were More Likely to Use Telehealth Than Others During the Pandemic, OEI-02-20-00522,
forthcoming.

3 OIG, Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks, OEI-02-20-00720, forthcoming.
Another related report looked at the extent to which beneficiaries received telehealth services from providers with whom they
had an established relationship. See OIG, Most Medicare Beneficiaries Received Telehealth Services Only from Providers with
Whom They Had an Established Relationship, OE|-02-20-00521. See also Pandemic Response Accountability Committee,
Telehealth Services in Select Federal Health Care Programs, forthcoming.

4 For example, prior to the pandemic, beneficiaries were allowed to use virtual care services, as well as telehealth services to
address substance use disorder or end-stage renal disease, from their home and in urban areas. In addition, beginning in
2020, beneficiaries enrolled in Medicare Advantage plans were allowed to use telehealth services in their homes and in urban
areas.

5 For the purposes of this study, we included the telehealth services approved for payment by Medicare as of February 28,
2021.

6 These services are also referred to as Communication Technology-Based Services. For the purposes of this report, we refer to
them as virtual care services.

7 Prior to the pandemic, beneficiaries could receive certain virtual care services, such as virtual check-ins, through audio-only.

8 See OIG, Most Medicare Beneficiaries Received Telehealth Services Only From Providers with Whom They Had an Established
Relationship, OEI-02-20-00521, October 2021.

° For example, plans could provide services to beneficiaries in their homes and regardless of their geographic location. See 84
F.R. 15680 (April 16, 2019).

10 Payment information is not available for beneficiaries enrolled in Medicare Advantage.

11 Unlike Medicare fee-for-service beneficiaries enrolled in Medicare Advantage plans were allowed to receive telehealth
services both from home and in urban areas as of January 1, 2020. Further, beneficiaries using virtual care services, as well as
those using telehealth for certain services such as substance use disorder treatment and end-stage renal disease, were able to
receive these services from home and in urban areas prior to the pandemic.

12 For the purposes of this report, we refer to "all services" as those approved services that were provided either via telehealth
or in-person during the pandemic or in the prior year.

13 See Centers for Disease Control and Prevention, Delay or Avoidance of Medical Care Because of COVID-19-Related Concerns
- United States, June 2020, September 11, 2020. Accessed at https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm on

Endnotes | 18
February 9, 2022. See also Commonwealth Fund, The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound
Emerges, May 19, 2020. Accessed at https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-
visits on February 18, 2022.

 

14 Virtual check-ins can also include evaluation of video or images submitted by a beneficiary.

15 See Medicare Payment Commission, Telehealth: Updates on use, beneficiary and clinician experiences, and other topics of

interest, November 8, 2021. Accessed at https://www.medpac.gov/wp-content/uploads/2021/09/Telehealth-MedPAC-Nov-
2021.pdf on December 8, 2021.

16 For more information about the use of telehealth in Medicare during the COVID-19 pandemic, see CMS, Medicare
Telemedicine Snapshot. Accessed at https://www.cms.gov/medicare-telemedicine-snapshot on December 6, 2021.

17 See the HHS-OIG Work Plan, which can be found at https://oig.hhs.gov/reports-and-publications/workplan/index.asp.

18 See OIG, Certain Medicare Beneficiaries Were More Likely to Use Telehealth Than Others During the Pandemic, OEI-02-20-
00522, forthcoming. See also, OIG, Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks, OEI-
02-20-00720, forthcoming.

19 The codes used in the analysis for this data brief include the list available on the CMS website as of February 28, 2021, which

can be found at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes. These codes

also include the Communication Technology-Based Services that were allowed during the first year of the pandemic. See 85
F.R. 19230 (April 6, 2020) and 85 F.R. 84472 (December 20, 2020).

20 All virtual care service codes were considered as being provided via telehealth as they can only be provided remotely.

21 We determined enrollment based on beneficiaries enrolled in Medicare fee-for-service or Medicare Advantage as of
February 28, 2021.

22 This payment amount does not include amounts paid by, or on behalf of, beneficiaries, such as a deductible or co-payment.

23 CMS's service classification system is known as the Restructured Berenson-Eggers Type of Service Classification System. For
more information see https://data.cms.gov/provider-summary-by-type-of-service/provider-service-classifications/restructured-
betos-classification-

system#:~:text=The%20Restructured%20BETOS%20Classification%20System,clinically420meaningful%20categories%20and%2
Osubcategories.&:text=The%20RBCS%20will%20underqo%20annual,panel%200f%20researchers%20and%20clinicians.

Data Brief: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19
Pandemic
OEI-02-20-00520 Endnotes | 19