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Is audio-only the future of telehealth for Medicare enrollees?

During the pandemic, many of the Medicare enrollees who utilized telehealth did so just by picking up the phone.

CMS reported that about a third of the Medicare beneficiaries who utilized telehealth in early 2020 did so simply by using their phone. | Image: Drobot Dean / stock.adobe.com

Access to care is important not only for emergencies but for management of chronic health conditions. Telehealth, also known as telemedicine, increased that access for millions of Americans during the pandemic.

After the government declared COVID-19 a national public health emergency, telehealth took off. The number of telehealth visits increased by more than 4,300% in March 2020 when compared to 2019. A survey by the RAND Corporation found that 53% of people with commercial insurance, including Medicare Advantage, used telehealth between March and May 2020. Former CMS director Seema Verma reported that more than 9 million Medicare beneficiaries used telehealth services during that time with a third of them simply doing so by phone.

Is telehealth here to stay?

Defining telehealth

Tele- is derived from Greek, meaning at a distance. Think about how long we have used tele- technology. The telephone was invented in 1876. This was followed by the first radio broadcast in 1900 and the first television broadcast in 1927.

The problem is in how telehealth is defined. It is stricter than healthcare “at a distance.” For the purposes of Medicare, telehealth was limited to “office visits, psychotherapy, consultations, and certain other medical or health services that are provided by a doctor or other healthcare provider who’s located elsewhere using interactive 2-way real-time audio and video technology.”

Passage of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) in March 2020 changed the requirements for telehealth coverage, at least during the public health emergency. Healthcare providers could deliver care by audio-only telehealth too.

Limitations of video conferencing

The video component appears to be the rate-limiting step. Not all Medicare beneficiaries have access to video conferencing technology and many may have physical limitations that decrease their ability to use it effectively, even when they do.

Take broadband connectivity. In 2020, there were more than 61.2 million Americans enrolled in Medicare coverage. Approximately one in five of them lived in rural communities. According to the Federal Communications Commission (FCC), one in four people living in these communities do not have access to broadband. Even when broadband services are available in rural communities, millions of Americans do not sign up for service whether for cost or other reasons.

Chronic medical conditions and disabilities also take their toll. According to the most recent National Health Survey, 9.2 million adults 65 and over have significant vision loss. When you consider that 23% of adults over age 40 report severe arthritis pain, dexterity issues could also come into play when it comes to using video conferencing equipment.

Easy access with audio-only services

It turns out the technology we needed all along was right in front of us! Telephones are easy to use and most people have access to one.

People who were unable to utilize video conferencing services, regardless of the reason, were able to have equitable access to care with audio-only services. The proof is in the pudding, as they say, with 3 million Medicare beneficiaries turning to their phones for telehealth visits in the first three months of the pandemic.

Physician shortages are another factor to consider. Rural counties account for the majority of designated health professional shortage areas in the country. People may have to travel long distances to see a provider, if they can access one at all. As noted previously, these areas are already at increased risk for broadband issues. Limiting telehealth to audio-video conferencing unfairly deprives care of people who are already at a disadvantage.

Legislative changes on the way

Medicare not only provided increased telehealth services during the pandemic, it increased access to care and overall convenience. It will do so through the public health emergency which is expected to continue through the whole of 2021.

Whether the expansion of Medicare telehealth services will continue after the pandemic remains to be seen. The General Accounting Office has recommended further study to assure the quality of care during telehealth visits is as good as in-person visits. They have also raised concern that the convenience of the service could lead to overuse and possible fraud or abuse.

Despite those concerns, legislation is being sought to extend coverage for audio-only telehealth for the long haul. The Permanency for Audio-Only Telehealth Act would allow audio-only visits to continue and would lift pre-pandemic restrictions on where beneficiaries were located during the call.

Previously, beneficiaries on Original Medicare had to be at a community mental health center, critical access hospital, doctor’s office, federally qualified health center, hospital, hospital- or critical access hospital-based dialysis facility, rural health clinic, or skilled nursing facility for their visit to be covered. They could not be at home. The one exception was people who required routine check-ups for home dialysis. The catch was that they had to have already received three months of in-person visits before telehealth visits would be covered.

Medicare Advantage plans were allowed to expand their telehealth access in 2020, before the pandemic even began. They are not necessarily restricted to fixed locations like Original Medicare. In fact, telehealth benefits can now be included as part of their basic benefits package.

The bottom line

Audio-only services may be the answer, at least for certain types of medical conditions. As many as 54% of people used telehealth for behavioral health conditions at the start of the pandemic and 43% used it for chronic medical conditions. It’s easy and it works.

Telehealth allows you to bypass travel to the office (saving time and gas) and receive care from the comfort of your own home, keeping you safe while also being cost-effective. As long as it is covered by Original Medicare or your Medicare Advantage plan, you will pay no more than you do for an in-person visit. In some circumstances, you could even pay less.

While it is unclear what legislation will pass in the future, one thing holds true. Telehealth services have changed healthcare. If you are someone who needs help, do not hesitate to reach out to your healthcare provide for a telehealth visit, if they offer them. If you are someone who could benefit from regular tele-healthcare, you may want to look closely at Medicare Advantage plans in your area.


Tanya Feke M.D. is a licensed, board-certified family physician. As a practicing primary care physician and an urgent care physician for nearly ten years, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization review and medical necessity compliance. She currently works as a physician advisor at R1 RCM, Inc., where she performs case reviews for hospitals nationwide.

Dr. Feke is an expert in the field, having Medicare experience on the frontlines with both patients and hospital systems. To educate the public about ongoing issues with the program, she authored Idiot’s Guides: Medicare and Medicare Essentials: A Physician Insider Reveals the Fine Print. She has been frequently referenced as a Medicare expert in the media and is a contributor to multiple online publications. As founder of Diagnosis Life, LLC, she also posts regular content about health and wellness to her site at diagnosislife.com.

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