Study: Out-of-State Telemedicine Visits Were Common During the COVID-19 Pandemic

The relaxation of out-of-state telemedicine restrictions could make it more convenient for certain populations to access medical care, according to a study published in JAMA Health Forum. The study authors also identified mental illness as the reason for many out-of-state telemedicine visits.

“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 in the report.

During the pandemic, most states temporality allowed medical practitioners in one state to treat patients living in another, which made it easier to access care, regardless of whether the practitioner was licensed in that state. Federal- and state-level debate persists about whether this policy should continue, according to the study authors.

A proposed solution is telemedicine licensures, which would allow medical practitioners to practice in all states that are part of the Medicare program. Another proposed solution is for states to join the Interstate Medical Licensure Compact, which would decrease the time it takes for a practitioner to receive an out-of-state medical license.

From January 2021 to June 2021, researchers conducted a cross-sectional study of all telemedicine visits made by patients who have traditional Medicare. They used these data to understand how out-of-state telemedicine was being used during the COVID-19 pandemic and who it would impact.

Researchers counted 8,392,092 telemedicine visits during this time. Among these patients, 422,547 (5%) had at least 1 out-of-state visit. Additionally, individuals living within 15 miles of another state’s border accounted for more than half (57.2%) of all out-of-state telemedicine visits.

Just over 62% of all out-of-state visits were with the same clinician that the individual saw at a previous in-person visit. There were noticeable differences in telemedicine use among certain demographics.

“Among those with a telemedicine visit, people in rural communities were more likely to receive out-of-state telemedicine care (33.8% vs 21.0%), and there was high of out-of-state telemedicine use for cancer care (9.8% of all telemedicine visits for cancer care),” the study authors wrote.

Limitations of the study include the population sample, who were only Medicare recipients. Additionally, the researchers determined out-of-state visits based on home address and the clinician’s practicing office, which might not reflect where the clinician is billed or is mainly based. The team also did not account for the differences between in-state and out-of-state telemedicine visits.

“The findings of this cross-sectional study suggest that licensure restrictions of out-of-state telemedicine would have had the largest effect on patients who lived near a state border, those in rural locales, and those who received primary care or mental health treatment,” the study authors wrote.

Reference

Mehrotra, Ateev, Huskamp, Haiden, Nimgaonkar, Alok, et al. Receipt of Out-of-State Telemedicine Visits Among Medicare Beneficiaries During the COVID-19 Pandemic. September 16, 2022. JAMA Health Forum. 2022;3(9):e223013. doi:10.1001/jamahealthforum.2022.3013