Audio-Only Technology Can Bridge the Telehealth Divide

With a successful vaccine rollout underway and declining fatality rates, hope is rising for a future free from the burdens of the COVID-19 pandemic – but the painful lessons of this public health crisis must not be overlooked.

At the top of that list is the importance of improving remote access to health care services for patients. This is particularly true for our nation’s older adults, many of whom live with multiple chronic conditions and, because of age, are at higher risk of serious illness from this infectious disease.

When COVID-19 struck, older adults were advised to stay home unless absolutely necessary and many doctors’ offices were closed for in-person visits to keep their patients and workforce safe. Enter telehealth. COVID-19 catapulted the use of this technology from a rarity to becoming a critical component of the health care experience.

The University of Michigan’s National Poll on Healthy Aging found that, “The percentage of older adults who had ever participated in a telehealth visit rose sharply from 4% in May 2019 to 30% in June 2020.” The same poll found that 46 percent of respondents indicated that their in-person appointments were canceled or rescheduled to telehealth visits by their health care provider.

Research also found that risk-based payment models such as Medicare Advantage and Programs for All-Inclusive Care for the Elderly enabled faster adoption of telehealth by providers than in Traditional Fee-for-Service Medicare.

The 40 percent of Medicare beneficiaries who have used telehealth services during the pandemic give the experience a 91 percent satisfaction rating, according to recent polling.

While the rapid transition to telehealth is encouraging, the numbers indicate that barriers still exist for many. A significant portion of the older adult population lacks the tools or capacity to complete a video telehealth appointment.

A study commissioned by the Center for Innovation in Medicare Advantage, a sister organization to the Better Medicare Alliance, showed that 34 percent of Medicare beneficiaries living under the Federal Poverty Level reported no internet usage at all, with similar findings (33 percent) for those ages 85 and older – inhibiting their ability to use audio-video forms of telehealth.

A separate study reported that nonwhite beneficiaries are among those least likely to use video technology to communicate with their providers.

To compensate for these barriers, older adults and those with disabilities are using audio-only means of telehealth, such as a simple phone call, to communicate with their providers. Even now, as we emerge from this yearlong trial, audio-only telehealth visits continue to ensure those most in need can receive timely care – particularly for older, minority, rural and lower-income older adults who are more likely to lack access to audio-video telehealth platforms and the necessary internet speeds to facilitate these appointments.

Research suggests 60 percent of Medicare beneficiaries choose this modality when given the option. Despite this, telehealth regulations have not caught up to this reality.

During the pandemic, health care providers were granted waivers to allow for audio-only telehealth appointments, but diagnoses obtained during these encounters are still not accepted for risk-adjustment purposes – an annual process required in risk-based models such as Medicare Advantage and PACE to report each beneficiary’s health status.

Fortunately, bipartisan legislation (H.R. 2166/S. 150) sponsored by Sens. Catherine Cortez Masto (D-Nev.) and Tim Scott (R-S.C.) and Reps. Terri Sewell (D-Ala.) and Gus Bilirakis (R-Fla.) has been introduced to remedy this situation.

This sensible measure would help bridge the divide that remains in telehealth usage by allowing data collected from audio-only telehealth visits during the ongoing pandemic to be used for risk-adjustment purposes, thereby ensuring complete and accurate reporting.

Without this legislation, health care providers during the public health emergency will not be able to obtain the necessary data for accurate risk-adjustment that is essential to the smooth functioning of Medicare Advantage and PACE organizations, risking negative consequences for years to come.

Telehealth has been a lifeline for older Americans amid COVID-19, but challenges persist. Limited access to broadband internet, financial constraints and functional limitations are real barriers for many vulnerable Medicare beneficiaries and PACE enrollees. Use of audio-only telehealth visits brings greater equity during the COVID-19 response, ensuring that all older adults have the opportunity to use virtual care options that meet their needs.

In these days of COVID-19, policymakers face many hard choices – but a choice between allowing audio-only telehealth and letting our nation’s older adults simply go without is not one of them. Congress must protect vulnerable older adults by passing this bipartisan legislation without delay.


Allyson Y. Schwartz is president and CEO of Better Medicare Alliance and a former member of the U.S. House of Representatives from Pennsylvania, serving from 2005-2015.

Katie Smith Sloan is president and CEO of LeadingAge, the association of nonprofit providers of aging services.

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