Millions of doctor visits and health checks were postponed or canceled to prevent the spread of COVID-19 early in the pandemic. In many other cases, these typical face-to-face visits were instead conducted by phone or video conference.

The use of these telemedicine appointments surged during the pandemic. However, there are concerns about the quality of care patients receive and whether telemedicine services are accessible to everyone.

Today’s WatchBlog post examines how the use of telemedicine has grown within the government’s health insurance programs Medicaid and Medicare. Together, these programs enroll about half of the US population. About 76 million low-income Americans are enrolled in Medicaid. Medicare provides insurance to approximately 64 million older Americans and people with certain disabilities. Collectively, these two federal programs serve individuals of all health conditions and ages.

How has the use of telemedicine changed?

Even before the pandemic, Medicaid recipients had flexible access to telemedicine services in most states. But Medicare beneficiaries were not. By law, Medicare paid for telemedicine services only in limited circumstances. For example, when access to in-person care is restricted by location. But during COVID-19, the Department of Health and Human Services (HHS), which oversees Medicare, has waived some of those restrictions. Despite these differences in pre-COVID access, we found a dramatic increase in telemedicine use in both programs.

For example, in March we reported on changes in telemedicine use among Medicaid recipients in five select states. We found that the number of telemedicine services in these states increased dramatically, 15 times above pre-pandemic levels (32.5 million in the 12 months from March 2020 to February 2021). To learn more about this increase, listen to the podcast by GAO Medicaid expert Carolyn Yocom.

As for Medicare, it issued a new report on Monday. The report found that telemedicine use under Medicare increased tenfold in the same month of 2020, from about 5 million services (April to December 2019) to more than 53 million services. I was. has also grown rapidly, increasing from about $306 million to about $3.7 billion during that time. To learn more about this increase, listen to the podcast by Leslie Gordon, a Medicare expert at GAO.

How equitable is access to care?

As the use of telemedicine grows, so does the question of access. For example, the technology used for video health checkups may not be available to everyone. Previous reports have shown that millions of Americans still do not have access to high-speed internet (broadband). And not everyone has the same level of technical knowledge.

Also, some providers, especially those in small clinics, may lack the necessary technology to conduct private and secure video visits. You may be unaware of the privacy and security issues it can pose. We believe HHS can do a better job of notifying patients of these potential problems.

Impact of telemedicine on quality of care

Video conferencing and telephone consultations with doctors can be helpful when in-person treatment is not available. But it has its limits. For example, doctors may not be able to diagnose problems, investigate injuries, or conduct physical exams over the phone. There were also comments that telemedicine may not be suitable for all patients. For example, we’ve heard concerns about using telemedicine to check up on children. Specifically, some officials we interviewed said it may be more difficult to get the child’s attention during telemedicine visits. Testing your reflexes and detecting other symptoms may also be more difficult. Providing effective physical therapy via video can also be difficult for those suffering from injuries and disabilities.

We examined how Medicare and Medicaid Service Centers (CMS) monitor the quality of care provided to ensure that people enrolled in these programs receive the care they need. CMS has found and recommended that Medicaid providers do not collect, evaluate, or report information about the quality of telemedicine provided by them.

Regarding the quality of Medicare telemedicine services, CMS has identified concerns such as the risk of harm to patients and the provision of medically unnecessary services (such as genetic testing). Despite these concerns, we found that CMS has not taken steps to assess the quality of care and does not currently have the information needed to do so.

As a result of our findings, we recommended that CMS better track and evaluate how Medicare telemedicine services are delivered, particularly the number of services offered via voice-only (telephone).

The impact of these potential access issues may further limit the usefulness of telemedicine. Learn more about Google’s commitment to telemedicine use for Medicaid and Medicare in our new report.