The provision of tele-behavioral health services by critical access hospitals and short-term acute care hospitals during the COVID-19 public health emergency

Purpose

This study examined how the telehealth (TH) flexibilities introduced during the COVID-19 public health emergency (PHE) affected in-person behavioral health (BH) and tele-behavioral health (TBH) patterns of use among Medicare Fee-for-Service beneficiaries receiving care at critical access hospitals (CAHs) and non-CAH short-term acute care hospitals.

Methods

We used the 2019–2021 5% Medicare Limited Data Set Outpatient and Carrier files to explore differences in TBH usage trends by hospital type in the pre-pandemic year of 2019 and during the pandemic (2020–2021).

Findings

The percentage of hospitals providing TBH services significantly increased from 2019 to 2020–2021 (CAHs: 9% to 17%–23%; non-CAHs: 3% to 21%–22%). Although CAHs had higher TBH usage rates (i.e., the percentage of BH visits conducted through TH) than non-CAHs in the pre-pandemic period, usage rates among non-CAHs (7%–25%) outpaced CAHs (5%–16%) across all census regions—particularly in the Northeast—during the pandemic. In 2021, non-CAHs were able to sustain the use of TBH at higher levels than CAHs across all census regions except for the South.

Conclusions

While both CAHs and non-CAHs took advantage of the PHE TH flexibilities and significantly increased the likelihood and levels of TBH services, non-CAHs realized higher TBH usage rates than CAHs. The increase in the use of TBH visits was not enough to curb the decline in in-person BH visits during the pandemic. Given efforts to expand broadband and improve digital literacy in rural areas, TH continues to have great potential to reduce rural–urban BH differences in access to BH services.