Ming-Ting Yang, Helena Temkin-Greener, Shubing Cai
Overall, E&M telehealth visits among beneficiaries with ADRD declined from 21% in 2020 to 8% in 2022, whereas the audio-only share remained stable at around 20%. Over half of audio-only visits were furnished by primary care providers. Among telehealth users, traditionally underserved populations were significantly more likely to rely exclusively on audio-only visits and less likely to use them as supplemental care. For example, higher adjusted probabilities of exclusive audio-only use were observed among Black individuals (+0.4 percentage points; P < .01) and rural beneficiaries (+0.8 percentage points; P < .01).
OBJECTIVES: The Medicare telehealth expansion increased telehealth use, but the utilization patterns of audio-only telehealth remain unclear among those with Alzheimer's disease and related dementias (ADRDs). We aimed to describe 2020 to 2022 trends in audio-only telehealth utilization and provider specialty and to examine variations in utilization patterns by patient characteristics within the ADRD population.
DESIGN: Cohort study.
SETTING AND PARTICIPANTS: We identified 5,021,632 Medicare beneficiaries with a diagnosis of ADRD enrolled in Medicare fee-for-service plans between 2020 and 2022.
METHODS: Using Medicare fee-for-service claims data from 2020 to 2022, we described the modality of evaluation and management (E&M) visits. We calculated the proportion of E&M visits delivered via telehealth and audio-only and described the provider specialty. To further explore the pattern of telehealth use during the later stages of the pandemic, we used 2022 data to classify telehealth users into audio-only, supplementary, and video-only categories. We examined its association with individual race, ethnicity, socioeconomic status, and rurality using a linear probability model and a multinomial logistic regression. Average marginal effects were estimated.
RESULTS: Overall, E&M telehealth visits among beneficiaries with ADRD declined from 21% in 2020 to 8% in 2022, whereas the audio-only share remained stable at around 20%. Over half of audio-only visits were furnished by primary care providers. Among telehealth users, traditionally underserved populations were significantly more likely to rely exclusively on audio-only visits and less likely to use them as supplemental care. For example, higher adjusted probabilities of exclusive audio-only use were observed among Black individuals (+0.4 percentage points; P < .01) and rural beneficiaries (+0.8 percentage points; P < .01).
CONCLUSIONS AND IMPLICATIONS: Audio-only telehealth services were consistently used by Medicare beneficiaries with ADRD during the study period. Continued coverage for audio-only services could be a potential approach to promote digital health equity for older adults with ADRD.