GAO Reports on Telehealth and COVID-19 Flexibility Findings

Center for Connected Health Policy

June 2021

While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed.

The United States Government Accountability Office (GAO) released testimony May 19th regarding their ongoing assessment of COVID-19 flexibilities within the Medicare and Medicaid programs, as required under federal pandemic response oversight provisions included the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Provided before the U.S. Senate Committee on Finance, the GAO focused its summarized findings around the effects of program flexibilities and preliminary observations related to telehealth waivers of certain federal requirements, as well as considerations regarding ongoing use. Telehealth waivers included allowing services to be provided remotely in all areas and settings, as well as expanding the types of providers and technologies that could be used, such as audio-only modalities. While the GAO reported telehealth flexibilities as critical to reducing obstacles of care, they also stressed considering its potential to increase program expenditures and stated that the quality of telehealth services has still not been fully analyzed.

GAO testimony highlighted Centers for Medicare and Medicaid Services (CMS) data on recent telehealth utilization:

-Medicare telehealth services increased from 325,000 services in mid-March to 1.9 million in late-April; then decreased to 1.3 million by June as it continued to steadily drop
-Nearly 40% of beneficiaries received office visits through telehealth; nearly 60% received mental health services via telehealth
-Internists and family practitioners were the primary provider specialties using telehealth, through which they delivered one-quarter of their services
-89 of the 146 newly available types of telehealth services could be furnished via landline phones
-More beneficiaries under age 65 received services via telehealth than those over age 65
-More beneficiaries in urban areas received services via telehealth than those in rural areas
-Similar proportions of beneficiaries across all racial and ethnic groups received services via telehealth

When highlighting potential considerations moving forward, the GAO added that preliminary observations show that due to lack of broadband and digital literacy, access to services via live video telehealth continues to be limited among those with low socioeconomic status, those over age 85, and those in communities of color. Given that CMS information indicated that telehealth services have continued as in-person visits have been able to increase, the GAO also suggested considering the potential for increased spending if payment parity requirements related to telehealth are maintained post-pandemic. In relation to fraud and program integrity, the GAO discussed the inability of CMS to determine many aspects of telehealth services, such as type of modality and specific location data, as well as the suspension of security rules that raise potential medical information privacy issues. In regard to quality of care via telehealth considerations, the GAO cited a study specific to Direct-to-Consumer telehealth companies potentially overprescribing antibiotics as their primary example, adding that CMS is still exploring how to measure quality related to services provided via telehealth.

GAO information was based upon interviews of federal and state officials and provider and patient groups regarding their telehealth experiences, in addition to reviews of federal laws and CMS guidance. Additional GAO data and reports can be found on their website.