Out-of-state telehealth visits common during pandemic

Key takeaways

• Of the more than 8 million patients with a telehealth visit in the first half of 2021, researchers found that 5% (n = 422,547) had an out-of-state telehealth visit.
• Patients who benefited most from waived licensure rules facilitating out-of-state telehealth use include those receiving primary or mental health care, those who live near a state border and those who live in a rural area or in an area with a lower physician workforce.

In the first half of 2021, more than 422,500 patients with Medicare had an out-of-state telehealth visit, a recent study published in JAMA Health Forum found.

“The use of telemedicine across state lines has historically been limited, in part because of state-based licensure laws,” Ateev Mehrotra, MD, a professor of health care policy at Harvard Medical School, and colleagues wrote. “Before the COVID-19 pandemic, most physicians could only care for a patient physically located in another state if the physician was also licensed in that state. Early in the pandemic, in an effort to ensure access to care, almost all states implemented temporary changes to make it easier for out-of-state physicians without a license in their state to provide care to their state’s residents.”

Aiming to inform policy debates surrounding permanent changes to medical licensure rules, Mehrotra and colleagues conducted a cross-sectional study to identify trends in out-of-state telehealth use during the COVID-19 pandemic. The researchers analyzed Medicare fee-for-service claims from January 2021 to June 2021, a period chosen since it was after the uncertainty of the early pandemic — thus allowing for a more stabilized health care system — but before temporary licensing regulations began to lapse.

Research revealed that of the 8,392,092 patients with a telehealth visit in the first half of 2021, 5% had one or more out-of-state telehealth visits. Those living within 15 miles of a state border (33.1%) accounted for more than half (57.2%) of all visits. Out-of-state patients were more likely to live in rural communities compared with in-state counterparts (33.9% vs 21.1%).

Mehrotra and colleagues also reported that most out-of-state patients (64.3%) visited a primary care (38.9%) or mental health clinician (25.4%). In addition, many out-of-state telehealth visits were for cancer care (9.8%), according to the researchers. Among 62.6% of out-of-state telehealth visits, a prior in-person meeting occurred between the physician and patient.

“We find that during a period where licensure regulations were temporarily waived, out-of-state telemedicine visits were common and used most by patients who live near state borders or in rural communities, those receiving primary care services and mental health treatment, and those receiving cancer care,” the researchers wrote.

Mehrotra and colleagues listed several limitations of the study, which include data being limited to the traditional Medicare population, potential inaccuracies of patient and clinician addresses, and the assumption that patients were at home for a telehealth visit.

The researchers concluded that the results demonstrate which populations would be most affected by restrictions of out-of-state telehealth, adding that relaxed policies would offer “immediate convenience” to patients living near state borders, those who reside in areas with a lower physician per capita count and those receiving primary and mental health care.

“These patients are subject to an accident of geography; 2 patients receiving the same care may have very different experiences,” they wrote. “A patient with a primary care physician who lives in the middle of a state can access care via telemedicine. However, a similar patient living near a state border with a primary care physician in the neighboring state now will have to physically travel to that appointment.”

References:

• Mehrotra A, et al. JAMA Health Forum. 2022;doi:10.1001/jamahealthforum.2022.3013.
• Out-of-state telemedicine visits among Medicare patients during pandemic. https://www.eurekalert.org/news-releases/964770. Published Sept. 16, 2022. Accessed Sept. 22, 2022.