News: Telemedicine uptake did not result in improved access, study finds

A greater telemedicine uptake among mental health specialists did not result in improved access to care for patients in communities with specialist shortages, according to a recent study published in JAMA Network Open.

Researchers sought to examine the association of the proportion of mental health specialists’ visits delivered via telemedicine and the share of their visits to patients living in rural, low-access-to-care, or distant communities. The cohort study examined Medicare fee-for-service claims for mental health specialist services between January 1, 2018, and December 31, 2023. Specialists were categorized into quartiles based on their 2021 telemedicine uptake.

The cohort included 17,742 mental health specialists categorized into quartiles based on their telemedicine uptake in 2021. The main outcome was the proportion of mental health specialists’ patients who lived in the following:

1. A rural area
2. An area with a mental health specialist shortage
3. A different state from their specialist
4. A community 20 miles or more from their specialist

Differential changes in outcomes between specialists in the higher and lowest telemedicine uptake quartiles were estimated using a difference-in-differences framework. A secondary analysis examined the changes observed due to established patients moving their residence compared to new patients.

Compared with 2018 and specialists in the lowest telemedicine quartile, specialists with the highest telemedicine use had 0.88 percentage points more visits with rural patients in 2023. Similar small changes were observed in the fraction of visits with patients living in mental health specialist shortage areas, in a different state from their specialist, and living 20 miles or more away from their specialist. Specialists with higher telemedicine use visited differentially fewer new patients by 2023 than those with lower use.

Historic mental healthcare disparities were considered in the study. This included wide geographic disparities, particularly between rural and urban areas. Telemedicine could enable mental health specialists to reach patients who live farther away in rural communities and communities with low access to care. According to researchers, the small differences were more likely the result of Medicare fee-for-service patients moving farther away from their specialists than those specialists seeing more new patients from the communities with low access to mental healthcare.

The study concluded that greater telemedicine uptake was associated with only small increases in the share of visits to patients in rural, low access-to-care, or distant communities. “Tailored policy interventions may be needed for telemedicine to reach its potential of improving mental health care of individuals with the greatest difficulty accessing it in their local community,” the researchers wrote.

Editor’s note: To read the full study, click here. To read additional coverage from JustCoding, click here.