In early March, U.S. health officials had a stark warning for older Americans: You are more at risk for complications if you contract Covid-19, so avoid leaving your home.
For Medicare's 62.5 million beneficiaries — the majority of whom are 65 or older and more likely to use medical services — this was more than an inconvenience or new threat. It meant needing to see a doctor could pose a dangerous choice.
Enter telehealth. As communities worked to stem the spread of the coronavirus through temporary business shutdowns and stay-at-home orders, lawmakers and regulators loosened policies to make remote health care through Medicare more broadly available during the public emergency.
Whether via video chat, a telephone call or other remote technology, telemedicine usage among Medicare beneficiaries spiked from pre-pandemic levels: At least 10 million Medicare beneficiaries have used telehealth since early March, according to a spokesperson for the Centers for Medicare and Medicaid Services. Before then, there were roughly 13,000 appointments weekly.
"I think it's pretty clear that the expansion in telehealth services was a very appropriate and successful response to the pandemic," said Juliette Cubanski, deputy director for the Kaiser Family Foundation's program on Medicare policy. "It was probably a lifesaver for people who took advantage of it, or it let them continue to get care."
Yet as Congress and regulators consider making the temporary expansion in telehealth permanent, patient advocates are hoping they don't move too quickly.
"We have data about increased utilization, but we don't know much about the beneficiary's experience and what's working and what isn't," said Lindsey Copeland, federal policy director for the Medicare Rights Center, an advocacy group.
Among the issues that policymakers would need to address are quality of care, the cost to beneficiaries and the services that are sensible for coverage.
"Using it for all circumstances and all services, as we've seen generally through the pandemic, might not be the best possible way forward from both a program cost perspective or beneficiary cost perspective," Cubanski said.
By the looks of it, most telehealth experiences have been positive among Medicare beneficiaries. Among those enrolled in an Advantage Plan, 91% reported favorable experiences with telehealth and 78% would use it again, according to a survey by the Better Medicare Alliance.
Similarly, an informal poll done in an 8,000-member Facebook Medicare group hosted by insurance agency Boomer Benefits showed that most respondents who had used telehealth liked the arrangement — often with the caveat that it wouldn't work for every medical issue encountered. Others questioned whether the cost should be the same as an in-person visit.
Debbie, a 65-year-old Medicare beneficiary living near Middletown, Delaware, used telehealth — a face-to-face video on her smartphone — to get treatment for a bout of poison ivy. For reasons that include the nurse practitioner's inability to see the allergic reaction in detail over video, she said she was unimpressed.
"I don't like it," said Debbie, whose last name is not being used for privacy reasons. "Even if you can see each other [on the screen], it's not the same as seeing someone in person."
Prior to the pandemic, telehealth already was on a path toward broader usage within Medicare. However, it was generally limited to rural areas, with restrictions on where the remote visit could take place and which providers were allowed to offer such care.
During the public health emergency, beneficiaries can be in their own home, and the menu of services and providers that qualify was greatly expanded, ranging from emergency department visits to group psychotherapy to radiation treatment management.
In Congress, there are several bills addressing telehealth expansion. The HEALS Act — introduced in the Senate as the Republican version of the next coronavirus relief package — includes a provision that would make the regulatory waivers permanent through the end of 2021. The Trump administration also is pushing for some permanency in telehealth usage with Medicare.
Another issue to address is Medicare beneficiaries' access to technology, as well as the know-how to use it. For some patients, that could be a barrier to care.
"If we have this expansion in telehealth, we have to do it in a way that doesn't leave those people further behind and increase existing disparities," Copeland said.
Policymakers would also need to identify which services are most appropriate for telehealth appointments.
"There's no question that there still needs to be in-person visits, but there are some that are highly appropriate for telehealth," said Allyson Schwartz, president and CEO of the Better Medicare Alliance and a former congresswoman from Pennsylvania.
For example, she said, check-ins for people with chronic conditions or mental-health consultations have worked well for those remote appointments.
"I don't think anyone thinks telehealth would replace in-person 100%," Schwartz said. "But there's a strong feeling that there is a role for telehealth visits."