Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID-19 pandemic.

Purpose: To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic.

Methods: A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type.

Findings: Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%-31%) than RHCs (8%-14%) in 2020-2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers. Overall, 19%-34% of originating site providers were psychiatrists and 10%-31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020-2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%-15.8% in rural) followed by rural ID_RHCs (10.2%-11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic.

Conclusions: Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020-2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.