Rural-Urban Differences in Availability of Telemedicine Services Among Medicare Beneficiaries During COVID-19

The COVID-19 pandemic has created substantial disruptions to all aspects of rural and urban U.S. life. At the same time, it has provided opportunities for shifts in health service delivery, including policy innovations to increase telehealth availability and use for diagnosis and treatment of health concerns. However, it is unclear whether rural residents, particularly older adults, have the same access to telehealth services as their urban counterparts. Rural providers may face unique barriers to delivering telehealth services, and rural patients may have more difficulty accessing those services from their homes. This study used the Fall and Summer 2020 Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files to examine rural-urban differences in the telemedicine services available to Medicare beneficiaries from their primary care providers, as well as their ability to access those services. Preliminary findings suggest that rural beneficiaries are less likely to have access to telehealth services during the pandemic, they were more likely to exhibit hesitancy towards receiving the COVID-19 vaccine, they were less likely to engage in preventive behaviors such as hand washing and sterilizing surfaces, and more likely to have missed diagnostic or medical screening tests (37%) compared to urban (27%) beneficiaries. Finally, rural beneficiaries were less likely to have a smartphone, computer, or tablet at home and less likely to have access to the internet (78% rural; 84% urban). Policy implications include the need for outreach efforts to better inform the provider community, and efforts to improve rural health system infrastructure available to support telehealth.

The Medicare Current Beneficiary Survey (MCBS): Providing Unique Access to Data on the Medicare Population

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Centers for Medicare & Medicaid Services (CMS). It collects data on demographics, health insurance, health status, health care expenditures, satisfaction with care, and access to care for Medicare beneficiaries. The MCBS provides a unique source of information regarding beneficiaries aged 65 and over and beneficiaries aged 64 and below with disabilities residing in the United States that cannot be obtained solely through CMS administrative sources. For researchers interested in issues of health care utilization and cost, CMS releases two Limited Data Set (LDS) files for each data year and a Public Use File (PUF) freely available for download and use. Also, special topic based PUFs have been released on the impact of COVID-19 on Medicare beneficiaries. This presentation will demonstrate the importance of the MCBS for research on the Medicare population, discuss how researchers can access the data, where researchers can find published MCBS estimates, what content areas have recently been added, such as food insecurity, limited English proficiency, and COVID-19 vaccination uptake and what new content is on the horizon. The presentation will also discuss the operational challenges posed by the COVID-19 pandemic, and the content enhancement opportunities created by the public health emergency. It will conclude with a review of the suite of materials and documentation available for data users to enhance their research and utilize more timely data.

COVID-19 Vaccine Hesitancy Among Older Adults: Evidence From the Medicare Current Beneficiary Survey

Objective Older adults have been the most enthusiastic cohort about the COVID-19 vaccine since its rollout. However, there is limited evidence on vaccine hesitancy, particularly among community-dwelling older adults. In this study, we examine the prevalence and predictors (especially information sources) of vaccine hesitancy in this group. Methods We use the Medicare Current Beneficiary Survey (MCBS)- Fall 2020 supplement data and employ multivariable logistic regression models to explore this association. We study heterogeneous effects by gender, metro/non-metro residence status, race, and age. Results Depending on healthcare providers (HCP), social media, the internet, and family/friends as the main COVID-19 information source was associated with higher odds of negative vaccine intent when compared to those who rely on regular news. We did not find any association of ‘unsure’ vaccine intent and different information sources. Discussion Recommendation from an HCP is a strong predictor of any vaccine acceptance and higher negative intent for COVID-19 vaccine among those who depend on HCP for information is concerning. This could be due to vaccine hesitancy among HCPs themselves or due to other mechanisms like infrequent interactions with the health system.

Telemedicine use in 2020 during the COVID-19 pandemic among community dwelling U.S. Medicare beneficiaries

Objective: CMS reimbursement regulations for telemedicine changed after the onset of the COVID-19 pandemic. This study aimed to assess telemedicine utilization patterns offered by health care providers and used by Medicare beneficiaries during the COVID-19 pandemic during 2020.Methods: This study used the Fall 2020 Medicare Current Beneficiary Survey (MCBS) supplemental COVID-19 survey to identify Medicare beneficiaries (≥ 65 years) with a regular place for medical care that offered telemedicine during 2020. Major outcomes: prevalence for whether telemedicine was offered before and during the pandemic, telemedicine use, and digital access to telemedicine. Logistic regression identified the demographic factors associated with telemedicine use.Results: The study sample included 4,380 eligible individual Medicare beneficiaries ≥ 65 years. Of those, 42.9% made telemedicine visits during the pandemic. Approximately 60% of the telemedicine visits were conducted via telephone. Telemedicine was offered to 18% of the respondents before the pandemic vs. 64% during year 2020 of the pandemic. Among telemedicine users, 57.2%, 28.3%, and 14.5% used voice calls, video calls, and both voice and video calls for health care appointments, respectively. Overall telemedicine use varied by sex, race, and region. Individuals 65-74 years, female, living in a metropolitan area, with higher incomes were more likely to make video visits. Experience using telecommunications via the internet influenced telemedicine use significantly.Conclusions: Telemedicine offered to older Medicare beneficiaries increased dramatically after the onset of the COVID-19 pandemic. Yet, less than half used telemedicine and differences in utilization existed by demographic characteristics.

High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017

<b>Objective</b> <p>We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries ages 65 years or older with diabetes overall, and by income level, by race/ethnicity, and compared to beneficiaries without diabetes. </p> <p><b>Research Design and Methods </b></p> <p>Using data from the 1999−2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.</p> <p><b>Results </b></p> <p>Total OOP costs were $3,609 to $5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57% to 72% at the 10% income threshold and 29% to 41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25−50% income quartiles. Non-Hispanic whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, <i>P</i> <0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, <i>P </i><0.01). </p> <p><b>Conclusions</b></p> Over the past 2 decades, Medicare beneficiaries ages 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.

High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017

<b>Objective</b> <p>We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries ages 65 years or older with diabetes overall, and by income level, by race/ethnicity, and compared to beneficiaries without diabetes. </p> <p><b>Research Design and Methods </b></p> <p>Using data from the 1999−2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.</p> <p><b>Results </b></p> <p>Total OOP costs were $3,609 to $5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57% to 72% at the 10% income threshold and 29% to 41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25−50% income quartiles. Non-Hispanic whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, <i>P</i> <0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, <i>P </i><0.01). </p> <p><b>Conclusions</b></p> Over the past 2 decades, Medicare beneficiaries ages 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.

Understanding Medicare With Hearing Loss

Medicare has become an increasingly complex program to navigate with numerous choices available to beneficiaries with important implications on their financial exposure and access to care. While research has identified poor health literacy as a barrier to understanding Medicare, little information is available on the experience of individuals with hearing loss. Using the Medicare Current Beneficiary Survey (2016), a nationally-representative sample of 10,841 beneficiaries, we examined if difficulty understanding Medicare was associated with reported trouble hearing, while controlling for socio-demographic and health literacy factors. Compared to no trouble, Medicare beneficiaries with a little or a lot of trouble hearing had 44% (95% CI OR:1.34-1.55) and 63% (95% CI OR: 1.44-1.83) increased odds of reporting greater difficulty with understanding Medicare. The existing tools to support Medicare beneficiaries understand and navigate the program must evolve to meet the needs of those with hearing loss- a highly prevalent condition among Medicare beneficiaries.