Out-of-state telehealth visits are common during a pandemic

October 04, 2022

2 minutes to read

Disclosures:
Mehrotra reported receiving personal fees from Black Opal Ventures, Pew Charitable Trust and Sanofi Pasteur outside the study. Please see the study for all relevant financial disclosures by other authors.


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  • Of the more than 8 million patients who visited telehealth services in the first half of 2021, researchers found that 5% (n=422,547) made a telehealth visit outside the state.
  • Patients who have benefited most from licensing rules that facilitate the use of telehealth services outside of the state include those receiving primary or mental health care, those who live near state borders and those who live in a rural area or in an area with a lower workforce than physicians.

In the first half of 2021, more than 422,500 patients with Medicare visited out-of-state telehealth, according to a recent study published in yAMA Health Forum have found.

“The use of telemedicine across state lines has historically been limited, in part due to state licensing laws.” Atif Mehrotra, MDAnd the Professor of Health Care Policy at Harvard Medical School, and colleagues wrote. “Before the COVID-19 pandemic, most doctors could only care for a patient physically located in another state if the doctor was also licensed in that state. Early in the pandemic, in an effort to ensure access to care, nearly all states implemented temporary changes to make it easier for Physicians are out of state without a license in their state to provide care to the residents of their state.”

PC0922Mehrotra_Graphic_01_WEB

Data are from: Mehrotra A, et al. Health forum gamma. 2022; doi: 10.1001/jamahealthforum.2022.3013.

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

Research revealed that of the 8,392,092 patients who visited telehealth in the first half of 2021, 5% had visited one or more telehealth services outside the state. Those who live within 15 miles of the state border (33.1%) account for more than half (57.2%) of all visits. Out-of-state patients were more likely to live in rural communities than their 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 practitioner (25.4%). Additionally, many of the out-of-state telehealth visits were for cancer care (9.8%), according to the researchers. Of 62.6% of out-of-state telehealth visits, a previous in-person doctor-patient encounter occurred.

“We found that during the period when licensing regulations were temporarily waived, out-of-state telemedicine visits were common and used mostly 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 limiting the data to the traditional medical care group, potential inaccuracies of patients and physician addresses, and the assumption that patients were at home for a telehealth visit.

The findings show which residents will be most affected by restrictions on out-of-state telehealth, the researchers concluded, adding that relaxed policies would provide “immediate relief” for patients who live close to state borders, and those who reside in areas with fewer physicians per capita. Number of individuals receiving primary and mental health care.

These patients are subjected to a geographical accident. They wrote that two patients receiving the same care may have had very different experiences. A patient who has a primary care physician who lives in the middle of a country can get care via telemedicine. However, a similar patient living near the state border with a primary care physician in the neighboring country would now have to physically travel to that appointment.”

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