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The Future of Telehealth: How Audio-Only Services Improve Access and Health Equity

As we reflect on the past year, COVID-19 has served as a catalyst, accelerating many healthcare trends. Telehealth is a great example of this. Prior to the pandemic, Medicare beneficiaries only had access to telehealth services if they lived in a designated rural area and traveled to a federally qualified health center (FQHC) for care. From a payment perspective, Medicare reimbursed for telehealth only if providers used both audio and video during the visit.


COVID-19 changed all that, however. In March 2020, the Centers for Medicare, and Medicaid Services (CMS) issued temporary actions, expanding telehealth during the COVID-19 public health emergency. Providers could conduct telehealth visits with patients in their homes and those patients didn’t need to live in a designated rural area. In addition, providers could bill for both video and audio-only telehealth consultations, as if they rendered those services in person.


Of all the temporary changes that CMS has made to telehealth rules, audio-only communications have the greatest potential for improving healthcare access and health equity for people nationwide.


Access to Healthcare Shouldn’t Require Internet Access


The reality is that many vulnerable populations are on the side of the digital divide where access to technology and broadband internet service is challenging at best. Research has shown that over 21 million American live in “digital deserts.” This is a problem for people in both rural and urban areas. In some cases, limited access to internet service is due to a lack of infrastructure and in others, it’s an affordability issue. The Pew Research Center has found that less than 65% of rural residents have a broadband internet connection in their homes and over 40% of low-income Americans lack broadband service in their homes.

For these individuals, audio-only telehealth visits have proven to be an effective tool for overcoming barriers to care like mobility challenges, a lack of transportation or a shortage of providers in close proximity. In addition, audio-only telehealth has opened up access to vitally important behavioral healthcare services.


Arthur C. Evans Jr., Ph.D., and CEO of American Psychological Association (APA) noted, “Allowing patients to receive mental health services by audio-only telephone is a matter of health equity for underserved populations and APA applauds this important equalizer.”

If CMS’ telehealth rules revert to requiring both audio and video components after the pandemic public health emergency, it will exacerbate healthcare disparities for African Americans and older individuals. Data gathered by the University of Alabama Birmingham revealed that African Americans were 28% less likely to use video during telehealth visits than Caucasians. In addition, patients 60 years and older were 42% to 49% less likely to use video than younger individuals.


Lessons Learned During COVID-19 Should Inform Long-Term Telehealth Policymaking

Eliminating CMS coverage for audio-only telehealth services at the end of the COVID-19 public health emergency would strike a serious blow to health equity advances made during the pandemic. The good news is that policymakers and healthcare advocacy groups are taking steps to ensure that audio-only telehealth is still an option for Medicare and Medicaid beneficiaries.


The U.S. House of Representatives recently introduced a bill to extend the use of audio-only telehealth services for seniors enrolled in Medicare Advantage plans and for members of the Program of All-Inclusive Care for the Elderly (PACE). This proposed legislation, which has generated support from both healthcare organizations and industry associations, would permanently allow providers to use certain audio-only diagnoses to determine risk adjustment for Medicare Advantage and PACE members. It would also continue reimbursement for audio-only telehealth services, as if they were rendered in person.

As Winston Churchill stated in the wake of World War II, “Never let a good crisis go to waste.” Today’s policy makers and healthcare stakeholders should take this philosophy to heart. COVID-19 has shown that telehealth can provide safe, convenient, and continuous access to care outside traditional care settings. Now is the time to take advantage of pandemic learnings and extend support for audio-only telehealth services to our Medicare and Medicaid populations.


This article was published in FIERCE Healthcare on May 17, 2021 with collaboration with HMS.

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