Telemedicine Travels Well

Yes, it’s another sports analogy to describe a market phenomenon in healthcare.

In sports, when we say, “defense travels well,” we mean defense plays as well on the road as it does at home. Unlike offense, which plays better at home than it does on the road.

A new study in JAMA Health Forum suggests that telemedicine also travels well. Telemedicine plays as well on the road as it does at home when it comes to getting patients the care that they need.

Researchers from Harvard, Beth Israel Deaconess Medical Center, Tufts, Penn and Duke wanted to know how many patients had a telemedicine visit with an out-of-state provider during the pandemic but after COVID-19  vaccines came out and patients could see their own doctor in person again. In other words, when patients had a choice between telemedicine and an in-person visit.

To find out, they studied the medical claims of about 8.4 million patients with traditional fee-for-service Medicare coverage who had a telemedicine visit between Jan. 1, 2021, and June 30, 2021.

Here’s what they found:

• The patients had a total of 17.9 million telemedicine visits during that six-month period
• Of those visits, a little more than 1 million, or 5.8 percent, were with out-of-state providers
• Nearly 60 percent of the telemedicine visits — 57.2 percent — were with out-of-state providers who were 15 miles away or less in another state
• But more than 40 percent of the telemedicine visits — 42.7 percent — were with out-of-state providers who were as far away as 180 miles or more in another state

Who were patients visiting with out of state?

Some 38.3 percent of the out-of-state telemedicine visits were with primary-care practitioners (internal medicine, family practice, general practice, geriatrics, nurse practitioners and physician assistants). The next biggest clinician category was mental health professionals (psychiatrists, neuropsychiatrists, clinical psychologists, licensed clinical social workers and behavioral health nurse practitioners).

And what were they seeing these virtual out-of-state providers for?

The five biggest clinical reasons were:

• Mental illness (25.8 percent of all out-of-state telemedicine visits)
• Heart disease (12.8 percent of all out-of-state telemedicine visits)
• Musculoskeletal problems (9.8 percent of all out-of-state telemedicine visits)
• Diabetes (8.9 percent of all out-of-state telemedicine visits)
• Neurological disease (7.4 percent of all out-of-state telemedicine visits)

The bad news in the study was who was using out-of-state telemedicine providers. It was predominantly younger, non-Hispanic white Medicare beneficiaries.

Some 44.6 percent of the beneficiaries who had one or more out-of-state telemedicine visits during the study period were 65 to 74 years old. And 82.7 percent of the beneficiaries who had one or more out-of-state telemedicine visits during the period were non-Hispanic whites. This clearly supports the idea of a digital health divide by age, race and ethnicity.

Still, the study does reveal that telemedicine does travel well, especially for those who have access to it. Many patients will choose an out-of-state virtual visit over an in-state in-person visit when it suits them.  That means state and federal licensure and practice restrictions that take away that option run counter to what patients want and what they need.

Such restrictions on telemedicine access particularly harm patients who live near a state border, who live in rural areas and who need primary care or mental health services, the researchers said.

Let’s give healthcare consumers, not protectionist providers, what they want.

Thanks for reading.