Telehealth expansion during the COVID-19 pandemic

Telehealth was rare in Medicare before the pandemic. In February 2020, 0.1 percent of Medicare fee-for-service primary care visits took place by telehealth, and in all of 2019 Medicare beneficiaries had roughly 840,000 telehealth visits.

That changed within weeks of the COVID-19 outbreak. Emergency 1135 waivers from the Centers for Medicare and Medicaid Services, starting on 6 March 2020, and the CARES Act, effective 27 March, together improved payment for telehealth, let clinicians serve patients in other states and allowed more types of providers to offer it. They also reduced or waived patients' cost-sharing, let federally qualified health centers and rural health clinics provide telehealth, and allowed virtual visits from patients' homes.

CDC researchers counted about 1.63 million telehealth encounters at four large telehealth providers in the first quarter of 2020, 50 percent more than in the same period of 2019, and in the last week of March the number was 154 percent above the previous year. By April, 43.5 percent of Medicare primary care visits were done by telehealth, as in-person visits fell steeply. The share ranged from about a third in Phoenix to nearly two-thirds in Boston, and rural providers saw smaller increases than urban ones. Use fell somewhat when offices reopened in May but leveled off at a high level by June.

Across 2020 as a whole, Medicare beneficiaries had about 52.7 million telehealth visits, a 63-fold increase over 2019, according to a federal study released in December 2021. Telehealth accounted for a third of all visits to behavioral health specialists that year, compared with 8 percent of primary care visits and 3 percent of visits to other specialists.