The review authors noted that video visits may require better internet and more equipment than audio appointments. Low-income patients might prefer audio-only visits because they lack privacy at home or are at work during appointments.
Medicare has dramatically increased its coverage of telehealth services during the pandemic, but that can only last during the COVID-19 public health emergency. Before the pandemic, Medicare only covered telehealth services for beneficiaries who received them from a health facility in rural areas, which accounted for less than 1% of total Medicare-paid visits.
Congress is considering permanently waiving these and other restrictions that limit audio-only telehealth coverage, citing inequities in internet access, especially in rural areas and among people of color.
President Joe Biden signed a $1 trillion infrastructure bill late last year, which includes $65 billion to improve broadband access in rural areas, but those projects could take several years.
Census data estimates that more than 13% of US households do not have the Internet, primarily among those earning less than $75,000 a year. A study by the Pew Research Center indicates that 97% of adults in the United States have a cell phone, but access to video varies by income and demographics. Split by race, 15% of blacks said they didn’t have a smartphone, compared to 11% of whites.
A study published last year in the Journal of the American Board of Family Medicine said current telehealth reimbursement rules could further exacerbate health disparities by excluding people without internet access or those with disabilities.