Primary care was top telehealth use for federal health programs in first year of COVID-19 pandemic

Primary care was front and center when telehealth use swelled in federal health care programs during the first year of the COVID-19 pandemic.

Offices of inspectors general from six federal departments and agencies collaborated on “Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic.” The study published this month by the Pandemic Response Accountability Committee (PRAC) examined telehealth use, along with risks of fraud, waste and abuse, across six federal programs involved in health care.

The overall result is probably not a surprise: Telehealth use skyrocketed when medical offices cautioned patients to stay away and patients feared infection.

From March 2020 to February 2021, the report found a total of 37 million patients used telehealth services, up from 3 million the 12 months prior, and the pandemic-year programs cost an estimated $6.2 billion.

In yearly comparison, Medicare had the greatest growth, with telehealth patients ballooning from 341,000 to 28 million, accounting for $5.1 billion in telehealth care the first year of the COVID-19 pandemic.

In Medicare and four other federal health care programs, primary care, or office visits with primary care or specialists, ranked as the most common use of telehealth.

More research needed

Christi A. Grimm, MPA
_{U.S. Department of Health and Human Services Office of Inspector General}

The PRAC noted its report did not cover every federal health care program or agency, but the figures could be important for public debate on future telehealth regulations.

“The PRAC’s approach – involving multiple OIGs to provide insights on issues that cut across federal agencies – provides a unique opportunity to assess how big changes in health care may affect multiple federal programs and the people they serve,” Christi A. Grimm, inspector general of the U.S. Department of Health and Human Services (HHS), said in a news release. HHS oversees Medicare spending and Grimm also leads the PRAC Health Care Subgroup.

“The rapid changes and growth of telehealth during the pandemic raised a lot of questions and this report provides objective and independent information to policymakers and other stakeholders as they consider the future of telehealth,” Grimm said.

Although there has been study about the effectiveness of telehealth, the federal regulators said the programs did not have “complete, reliable data” on quality of care and billing, which are “critical to conducting oversight of fraud, waste, and abuse.”

Other agencies

The other programs included in the study were the TRICARE health care program for active-duty military members and their families; Federal Employees Health Benefits Program in the Office of Personnel Management (OPM); the Veterans Health Administration (VHA); the U.S. Department of Labor (DOL) Workers’ Compensation Programs; and the U.S. Department of Justice Bureau of Prisons’ (DOJ-BOP) prisoner health care services. DOJ-BOP listed psychiatry as its main use for telehealth, the only one of the six that did not include primary care among the most common type of telehealth services during the study time.

As a percentage of users, the VHA had the greatest proportion of telehealth users, with 87% of veterans using telehealth. In Medicare, 43% of users had telehealth services, lower than TRICARE (49%) but more than the federal employee benefits program (40%), DOL workers’ comp (11%), and DOJ-BOP (2%), the federal study said.

It appeared telehealth already was established in VHA care, because VHA had 2.3 million telehealth users before the pandemic, growing to 4.8 million in the first year of the pandemic.

Fraud risks

The inspectors general identified “integrity risks” that were similar across multiple programs. For example, HHS, OPM, and DOL identified providers that billed at the highest level of service for a large proportion of telehealth services. HHS identified more than 300 Medicare providers who billed for telehealth services at the highest, most expensive level every time, totaling about $5.2 million.

Other risks include:

• Duplicate claims. HHS identified 138 providers who repeatedly billed Medicare fee-for-service and a Medicare Advantage plan for the same telehealth service, the report said.
• High-volume billing, which could indicate billing for services not provided or not necessary.
• Billing for services seemingly not appropriate for telehealth, such as wound debriding or anesthesia.
• Ordering inappropriate durable medical equipment or laboratory tests based on telehealth visits.