CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions

 CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions, 

As policymakers consider permanent telehealth policy changes, tracking the latest data has become increasingly important, in addition to breaking down data highlights and differences. Two new Centers for Medicare & Medicaid Services (CMS) Data Highlight reports were recently released that look at telehealth trends amongst Medicare patients during the pandemic. In addition, a Government Accountability Office (GAO)report submitted to Congress in early February assessed telehealth expansion impacts related to mental healthcare access for military service members. Key findings from the CMS data include that telehealth may reduce hospital readmission rates and disparities and improve opioid use disorder (OUD) treatment access. Meanwhile the GAO report showcased the importance of telehealth education to both providers and patients in ensuring access to care via telehealth.

CMS Data – Telehealth Impacts & Disparities on Follow-Up Care and OUD Treatment Access

The first CMS Data Highlight report, CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions, looked at hospital readmission rates, which are typically viewed as key indicators in determining quality of care and potentially poor post-discharge follow-up care. CMS has sought to reduce excess readmissions over the years through its Hospital Readmissions Reduction Program, which assesses certain health conditions including heart failure, pneumonia and chronic obstructive pulmonary disease (COPD), as well as specific surgical procedures – coronary artery bypass and elective hip and/or knee replacements. As the brief notes, only with recent pandemic policy changes, has the ability to utilize and study telehealth as a modality for post-discharge follow-up care become possible.

The report used Medicare beneficiary sociodemographic data as well as Medicare claims data from April 1, 2019 – September 30, 2020 to look at hospitalizations and determine any notable telehealth impacts on post-discharge follow-up care and readmission rates within 30 days of discharge date. The study also assessed differences by modality, finding that synchronous audio/visual telehealth accounted for the majority of follow-up visits, with use increasing from 61%-69% while audio-only use decreased from 39%-31% during the same timeframe. Notably, the brief ultimately found no exacerbation of pre-COVID disparities in use of post-discharge follow-up, rather the findings suggest that continued telehealth policy expansions may help increase follow-up and reduce readmissions among underserved populations. However, given disparities in broadband access combined with finding potentially greater willingness and/or capacity of minority beneficiaries to adopt telehealth, the report cautions that if telephone visits are not maintained in permanent policies, some of the initial adoption could be at risk.

The second CMS Data Highlight report, Changes in Access to Medication Treatment during COVID-19 Telehealth Expansion and Disparities in Telehealth Use for Medicare Beneficiaries with Opioid Use Disorder, looked at access to medications for treating opioid use disorder (OUD). The data also pointed toward telehealth expansions improving access and found that beneficiaries accessing OUD care had lower use of inpatient and/or emergency department visits indicating that better access may reduce more costly care. Among OUD beneficiaries, few disparities in telehealth use were found based on race, ethnicity, or social deprivation levels, but there were disparities discovered based on Medicare eligibility, dual eligibility status, and rurality. Generally, Medicare beneficiaries over 65, beneficiaries not dually-eligible for Medicare and Medicaid, and those in rural areas were found to utilize telehealth less. Beneficiaries with the highest rates of utilization were those with OUD in addition to other more complex health needs.

GAO Study – DOD Audit Shows increase in Telehealth Utilization and Education

In early February, the GAO provided a report to Congress, Defense Health Care: DOD Expanded Telehealth for Mental Health Care during the COVID-19 Pandemic, that examined multiple sources, including relevant Department of Defense (DOD) policies and mental health reports from March 2020 to November 2021, as well as Defense Health Agency (DHA) utilization data from January 2019 to April 2021. Interviews across agencies and each branch of the military were also conducted for purposes of the study.

Focusing its findings on active duty servicemembers, pre-pandemic telehealth visits were found to make up 15% of mental health care visits, with that number increasing by 275% over the first few months of 2020 as the DOD shifted its care delivery in response to the pandemic. The utilization rates began decreasing by April of 2020 and in April 2021 were 33% of all mental health care visits. Some of the main policies found to accommodate the greater use of telehealth included disseminating information to mental health providers to assist them in delivering care via telehealth, amongst other provider resources. Online training was also provided and helpful information on mental health was provided to servicemembers as well. DOD officials stated the value of telehealth and its ability to improve access and continuity of care. In addition, officials suggested that telehealth may reduce the stigma of seeking mental health treatment by allowing servicemembers to receive care more privately without the risk of being seen in military treatment facilities.

Looking Ahead – Data Download

Access, disparities, and utilization continue to be issues of great interest in the latest studies and policymaker discussions around post-pandemic telehealth policy. While data may help inform necessary policy steps, findings continue to vary and much of the information available is largely limited to certain populations, modalities, services, and time periods. Therefore, it remains important that policymakers also keep data disparities in mind as to not inappropriately generalize specific findings while also allowing ample time for gathering more information before making any drastic conclusions or changes.

For more information on CMS Data Highlights and the two studies mentioned you can review the CMS website. Please access the GAO report in its entirety for its additional findings.