Title: Quality of Care and Privacy Risks with Medicare Telehealth
Services During COVID-19

Description: Before the pandemic, Medicare only paid for telehealth
services under limited circumstances-for example, when access to
in-person care is limited by location. But during COVID-19, the
Department of Health and Human Services, which oversees Medicare, waived
some of its restrictions. While this may have provided greater access to
care, there are some concerns about the quality of care Medicare
recipients received and their privacy. Today, we'll find out more from
GAO's Leslie Gordon, an expert on Medicare and a director in our Health
Care team. Thanks for joining us.

Related GAO Work: GAO-22-104454, Medicare Telehealth: Actions Needed to
Strengthen Oversight and Help Providers Educate Patients on Privacy
and Security Risks

Released: September 2022

[Music]

[Leslie Gordon:] There's a need to strengthen oversight of telehealth
services before policymakers are making decisions.

[Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for
news and information from the U.S. Government Accountability Office. I'm
your host, Holly Hobbs. Before the pandemic, Medicare, which is the
government's health insurance program for older Americans and those with
certain disabilities, only paid for telehealth services under limited
circumstances-for example, when access to in-person care was limited by
location. But then during COVID-19, the Department of Health and Human
Services, which oversees Medicare, waived some of its restrictions.
While this may have provided greater access to care, there are concerns
about the quality of care Medicare recipients received and their
privacy. Today, we'll find out more from GAO's Leslie Gordon, an expert
on Medicare and a director in our Health Care team. Thanks for joining
us.

[Leslie Gordon:] Thanks for having me today, Holly.

[Holly Hobbs:] So, Leslie, how did telehealth change during COVID-19?

[Leslie Gordon:] Holly, we saw a tenfold increase in the use of
telehealth services. We went from 5 million services to 53 million
services. And the time period we looked at was April to December of
2019, pre-COVID-comparing that to April to December of 2020. We also saw
the number of beneficiaries increase from one and a half million
accessing telehealth services to over 14 million. Mental health and
behavioral health professionals increased the most, delivering about
half of their services every month. Interestingly enough, 5% of
providers delivered 42% of telehealth services. And when we looked at
urban versus rural providers, we saw that urban providers delivered a
higher percentage of their telehealth services compared to rural
providers.

[Holly Hobbs:] So we were worried about the quality of care provided
through telehealth visits. But why would a telehealth visit differ from
an in-person doctor's appointment?

[Leslie Gordon:] They're essentially different visits, right? You can't
diagnose. You can't look at somebody's infection. You can't look at
their wound. You can't do any kind of physical exam when you're on a
phone. And when you're on video technology, you can do it only to a
limited degree.

[Holly Hobbs:] So the quality of care provided could differ
significantly when appointments are done by phone verses video verses
in-person, right? HHS's Centers for Medicare & Medicaid Services (or
CMS) is supposed to monitor quality of care. Are they tracking which
appointments are video vs phone?

[Leslie Gordon:] Because CMS can't identify all of the audio-only
services, they are not able to study that in a sense. And we found that
not only was CMS not able to identify which services were audio versus
video technology, we also found that CMS had not assessed the quality or
had no plans to assess the quality of telehealth services generally.
They have done some work to identify potential indicators of quality
services that could be applied to telehealth services. It's essential to
know whether they are medically necessary, equitable, and whether they
lead to improved health. It's also important because right now CMS is
paying the same amount whether you go in-person, you have a video visit,
or if you talk to your doctor on the phone.

[Holly Hobbs:] Another concern is about privacy right? HHS's Office for
Civil Rights is responsible for enforcing HIPAA, which is all about
patient privacy and the security of their health information. Do these
new technologies pose any new risks to HIPAA?

[Leslie Gordon:] We looked into the privacy and security of telehealth
services, particularly since HHS's Office for Civil Rights relaxed its
enforcement of privacy and security rules during the pandemic. Now, this
was essential for people to be able to connect to their doctors,
whatever the video technology platform. We also knew, though, that some
telehealth platforms that were being used likely didn't meet the privacy
and security requirements. And again, HHS's Office for Civil Rights said
it wasn't going to enforce those standards during the pandemic. The
problem was the agency doesn't know if providers are explaining the
risks to their patients. And here we are more than two years later, HHS
Office for Civil Rights still isn't enforcing the privacy and security
requirements and we don't know who's aware of those risks.

{MUSIC}

[Holly Hobbs:] So, Leslie just told us that telehealth use under
Medicare was expanded during the pandemic to allow patients to access
health services when they otherwise might not have been able to. But
that there are concerns about the quality of care patients receive and
their privacy, which HHS and CMS are not yet monitoring. So Leslie,
given some of the oversight issues we identified in our report, what
actions do we think HHS and CMS should take?

[Leslie Gordon:] We're making recommendations to CMS to better track
audio-only telehealth services. And that's really essential for
understanding quality. Also, we are recommending that CMS plan to
comprehensively assess the quality of telehealth services, including
audio-only services. Without that, there's no way to ensure that
telehealth services are medically necessary, equitable, and lead to
improved health. And finally, Holly, we're recommending that the Office
for Civil Rights provide additional outreach or education to providers
so that they're fully explaining the privacy and security risks of using
telehealth platforms when they're meeting with their patients.

[Holly Hobbs:] And last question, what's the bottom line of this report?

[Leslie Gordon:] There's a need to strengthen oversight of telehealth
services, including assessing the quality of those services, before
policymakers are making decisions to expand or extend telehealth access
for the long term.

[Holly Hobbs:] That was Leslie Gordon talking about our new report on
Medicare and telehealth oversight. Thanks for your time, Leslie.

[Leslie Gordon:] It was great to talk with you.

[Holly Hobbs:] And thank you for listening to the watchdog report. To
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