TOPLINE:

Greater use of telemedicine among mental health specialists treating Medicare fee-for-service (FFS) beneficiaries was associated with only modest increases in visits with patients in rural, low-access, or distant communities, new research showed. However, it did provide convenience for existing patients who moved farther away from their specialists.

METHODOLOGY:

• A cohort study included outpatient visits of mental health specialists from 2018 through 2023 recorded in Medicare FFS claims data categorized as telemedicine (video or audio) or in person.
• The analysis included nearly 18,000 mental health specialists, including psychiatrists, psychologists, clinical psychologists, neuropsychiatrists, licensed clinical social workers, and psychiatric mental health nurses, who practiced throughout the study period in the US.
• The specialists were categorized into four quartiles on the basis of their telemedicine use in 2021: lowest (0%-40% of visits), low-middle (41%-79%), middle-high (80%-98%), and highest (99%-100%).
• Outcomes included the proportion of visits with patients residing in areas with a shortage of mental health specialists (counties without a psychiatrist’s practice zip code in 2019), rural areas (nonmetropolitan zip codes), states different from their specialist’s, and areas 20 or more miles away from their specialist’s practice location. A secondary analysis examined the percentage of new patients (defined as those not seen by the specialist in the previous 2 years) vs established patients.

TAKEAWAY:

• Specialists with the highest telemedicine use had only small increases from 2018 to 2023 in visits from rural patients compared with specialists with the lowest telemedicine use (0.88 percentage points; 95% CI, 0.35-1.40 percentage points).
• Modest increases were observed for visits from patients residing in mental health specialist shortage areas (0.12 percentage points) or in another state (0.95 percentage points); greater increases were found for those living 20 or more miles away (2.62 percentage points).
• After controlling for patients who moved residences, the differential increase in visits from patients in different states decreased to 0.29 percentage, and visits for those residing 20 or more miles away decreased to 1.45 percentage points.
• Specialists with higher telemedicine use had fewer new Medicare FFS patients by 2023 than those with lower use (-3.55 percentage points), suggesting telemedicine may reduce specialist capacity for new patients by extending care duration for established patients, the researchers noted.

IN PRACTICE:

“Simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care,” investigator Ateev Mehrotra, professor in the Department of Health Services, Policy and Practice at the Brown University School of Public Health, Providence, Rhode Island, said in a press release.

“For telemedicine’s potential to be reached, we need policy interventions to address those barriers. Improving how we license physicians is a critical first step,” Mehrotra added.

SOURCE:

The study was led by Jacob Jorem, MD, Harvard Medical School, Boston. It was published online on March 05 in JAMA Network Open.

LIMITATIONS:

The dataset excluded services provided at federally qualified health centers. Geographic measures were based on patients’ home addresses, which may have contained inaccuracies and did not capture situations such as patients being on vacation in another state at the time of the visit.

DISCLOSURES:

The study was funded by the National Institute of Mental Health. One investigator reported membership with the National Advisory Council on Alcohol Abuse and Alcoholism, and another reported receiving grants from the National Institutes of Health and personal fees from Black Opal Ventures. The other investigators reported having no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.