Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States

Abstract

Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004-14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was notable variation across states: In 2014 nine had more than twenty-five visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. States with a telemedicine parity law and a pro-telemental health regulatory environment had significantly higher rates of telemental health use than those that did not.

Utilization of Interactive Clinical Video Telemedicine by Rural and Urban Veterans in the Veterans Health Administration Health Care System

“…Rural veterans relied on video telemedicine at a higher rate, 200 video telemedicine visits per 1,000, half of which were for mental health. Although difficult to compare because of differences in methodology and definitions of telemedicine, recently published reports based on Medicare claims suggest that rural Medicare beneficiaries averaged approximately seven annual telemedicine visits per 1,000 beneficiaries, and approximately 50 per 1,000 mental telemedicine visits among beneficiaries with a mental illness diagnosis . Thus, VHA is a national leader in utilizing video telemedicine as an important component of its health care system.…”

“…In addition, adoption of telemedicine in the US commercial health care system has been relatively slow due in part to lower reimbursement rates, regulations preventing physicians from practicing across state lines, patient and provider unfamiliarity with technology, and lack of information technology capacity necessary to support real‐time video telemedicine . Recently, commercial providers of telemedicine report rapid growth in users and use among Medicare beneficiaries has also increased rapidly, although absolute rates of use remain low …”

Patterns of Telehealth Use Among Rural Medicaid Beneficiaries

“…Several factors may account for our observation that psychotropic medication management was the predominant form of telehealth use regardless of beneficiary residence. This pattern may reflect the fact that psychiatric evaluation and management procedures are conducted almost exclusively via verbal interactions between provider and patient and may be more readily adapted to telehealth than are specialty services that more often require in‐person physical examinations . The relatively high prevalence of telehealth‐delivered psychiatric services across levels of rurality may also relate to the ubiquity of unmet need for psychiatric care.…”

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

“…There is a preponderance of evidence that TMH is effective across a wide range of diagnoses and populations . Though TMH is particularly well‐suited to delivering care from a distance, adoption has been negligible in Medicare, Medicaid, and the private insurance sector …”

“…4 Though TMH is particularly well-suited to delivering care from a distance, 5 adoption has been negligible in Medicare, Medicaid, and the private insurance sector. [6][7][8] TMH can be delivered with a range of intensities, from curbside consultation to referral for ongoing care. 9,10 The 2 most effective models of TMH are collaborative care and referral care.…”