Medicare Restriction of Telehealth Speech Services Negatively Impacts Patient Care

Objective Ample literature shows voice and swallowing therapy, in‐person or virtual, to be essential for Otolaryngology and Speech‐Language Pathology care. In March 2023, Medicare announced discontinuing teletherapy reimbursement in hospital‐based outpatient departments, effective May 2023. This decision was subsequently reversed; however, the uncertain interval period provided the opportunity to study the impact of eliminating teletherapy. Study Design Prospective cohort. Setting Tertiary laryngology center. Methods Affected Medicare patients were contacted via mailed letter, phone, and secure patient portal and offered to change appointments to in‐person, teletherapy with cash self‐payment ($165‐282/session) or cancellation. Demographics and responses were collected. Statistical analyses conducted using Student's t test. Results Fifty‐three patients (28 female; mean age 66.8 ± 14.2 years) were impacted. 64% (n = 34) changed to in‐person appointment, 28% (n = 15) canceled, 8% (n = 4) did not respond. No patients opted to self‐pay. 67% of patients that canceled telehealth care cited distance from in‐person care location. The mean distance for canceled versus rescheduled patients was 92.3 ± 93.0 versus 32.8 ± 57.4 miles, P = .034. Mean age, gender, and number of sessions were not different between groups. Mean time to third next available therapy appointment was 96 ± 46 versus 46 ± 12 days before and after rule change, P = .007. Upon Medicare's reversal, this trend rebounded to nearly baseline (mean 77 ± 12 days, P = .12). Conclusion Medicare's discontinuation of reimbursement for teletherapy services caused nearly 30% of patients to cancel voice and swallowing therapy, primarily due to distance. These cancellations led to decreased access to care for Medicare patients with voice/swallowing diagnoses, which affect function, quality of life, and potentially even mortality risk.