Study: Limiting out-of-state telehealth could disrupt existing patient-provider relationships

JAMA Health Forum published a cross-sectional study suggesting reimplementing that licensure restrictions on out-of-state telemedicine, which were lifted due to the COVID-19 pandemic, would have the most significant effect on patients living near a state border, those in rural locations, and those receiving primary care or mental health treatment. 

“Relaxation of state restrictions would likely offer immediate convenience to patients who live near a state border and those receiving primary care and mental health treatment,” the study’s authors wrote. “These patients are subject to an accident of geography; two patients receiving the same care may have very different experiences. 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.”

WHY IT MATTERS

When COVID-19 emerged, many states temporarily allowed physicians to provide care in states in which they did not hold a license, thus allowing for the increased availability of providers to those in areas with fewer medical facilities and resources. 

Researchers aimed to determine which patients and specialties were using out-of-state telemedicine visits among Medicare beneficiaries during COVID-19. They analyzed 100% Medicare fee-for-service (FFS) claims from January through June 2021.  

This period was chosen because it was after the impact of the early pandemic, when vaccines were available and the healthcare system stabilized but before temporary licensing regulations began to lapse. 

Researchers noted that in the first half of 2021, 8,392,092 patients had been seen by a provider via telemedicine, 5% of which had one or more telemedicine visits with an out-of-state provider.

Patients living in a county close to a state border accounted for 57.2% of all out-of-state telemedicine visits, and 64.3% of those out-of-state visits were with a primary care or mental health clinician. In 62.6% of all out-of-state visits, prior in-person visits occurred between the same patient and healthcare provider.

Compared with patients who only had in-state telehealth appointments, those accessing out-of-state care were more likely to be dual-eligible for Medicaid and live in rural areas. 

Researchers note there are limitations to their analysis, including its concentrated focus on the Medicare population, and its evaluation based on the patient’s home address and the clinician’s practice address, which could be inaccurate. They also focused on patients who had in-state and out-of-state telemedicine visits, not ones who had telemedicine visits in general.