Pandemic Surge in Telehealth Did Not Worsen Healthcare Disparity: Johns Hopkins researchers

Findings reported in this month’s Health Affairs show high use of telehealth in disadvantaged neighborhoods among beneficiaries after Medicare restrictions on telehealth were waived.

Use of telehealth services surged during the early days of the COVID-19 pandemic. The rate has fallen off since, yet telehealth has now been braided into the provision of U.S. healthcare services and with it have come some hopes that the convenience of telehealth will have a ripple effect on access, continuity of care, adherence and a host of other issues.

But one of the concerns about telehealth has been that its use (and benefits) is far from uniform. More particularly, a number of studies have found disparities in telehealth use by race, ethnicity and some indicators of socioeconomic status. The findings fit with an overall observation that introductions of new technology and services in U.S. healthcare can widen disparity gaps rather than close them.

Findings reported in this month’s issue of Health Affairs won’t extinguish the concern about the unequal effect of telehealth completely, but they may allay them some.

Sanuja Bose and other researchers at Johns Hopkins found that after CMS waived telehealth restrictions in March 2020 because of the pandemic, people living in the most disadvantaged neighborhoods had highest odds of using telehealth services relative to those living in the least disadvantaged neighborhoods.

“Overall, our findings are encouraging as they suggest that the Medicare telemedicine coverage waiver could improve access to health care for people in the most disadvantaged U.S. neighborhoods without worsening disparities,” they wrote in Health Affairs.

Their analysis showed, though, that increasing age and living in a rural area were still associated with lower odds of telemedicine use after the waiving of the Medicare telehealth restrictions. The waiver eliminated geographic restrictions on the telehealth visits that Medicare covered and allowed providers to bill a telehealth visit at the same rate as an in-person one.

The study was distinguished partly by its size. Using Medicare fee-for-service claims data, Bose and colleagues compared more than 30 million patients with at least one outpatient visit claim in a prewaiver period (Jan. 1, 2019 to March 5, 2020) to 28 million patients with at least one outpatient visit in a postwaiver period (March 7, 2020 to March 31, 2021). Of the 30 million prewaiver visits, just .42% (129,114) were conducted via telehealth whereas 9.97% (2,795,242) were conducted via telehealth.

The Johns Hopkins researchers also used a composite metric called the Area Deprivation Index (ADI) to capture a fuller picture of people’s relative advantage and disadvantage. The ADI includes income, education, employment and housing quality data and organizes it at the census block group level.