NEW YORK (Reuters Health)—Contrary to previous research, mandating commercial insurance reimbursement of telemedicine was not associated with faster growth in Medicare telemedicine use, according to a newly published study.
Dr. Ateev Mehrotra of Harvard Medical School, Boston, and colleagues examined trends in telemedicine utilization by Medicare from 2004–2013 using claims from a 20% random sample of Medicare beneficiaries.
They defined a telemedicine visit as an encounter “with a GT (via an interactive audio and video telecommunications system) or GQ (via an asynchronous telecommunications system) modifier on the Current Procedural Terminology code or a telemedicine-specific code to a rural beneficiary (29% of all beneficiaries).”
To assess the connection between state parity laws mandating commercial insurance coverage for telemedicine visits—which previous studies suggested might drive higher utilization within Medicare—they compared 2013 Medicare telemedicine use and growth from 2004-2013 in the 12 states that had parity laws and 38 states without such laws as of 2011, they report in JAMA, online May 10.
Telemedicine visits among rural Medicare beneficiaries increased from 7,015 in 2004 to 107,955 in 2013 (annual visit growth rate, 28.0%).
Among the 41,070 (0.7%) rural beneficiaries who received a telemedicine visit in 2013, the mean number of visits came to 2.6. Although most visits occurred in outpatient clinics, 12.5% took place in a hospital or skilled nursing facility. Those with mental health conditions accounted for 78.9% of visits.
Beneficiaries who had a telemedicine visit in 2013 were more likely to be covered by Medicare due to disability, be younger than 65, have more comorbidities, and live in poorer communities than beneficiaries who did not have a telemedicine visit.
Telemedicine use in 2013 came to 8.5 visits per 1,000 beneficiaries in states with parity laws, compared with 6.2 visits per 1,000 beneficiaries in states without parity laws. Growth in visits per capita did not differ between the two sets of states.
“Although the number of Medicare telemedicine visits increased more than 25% a year for the past decade, in 2013, less than 1% of rural Medicare beneficiaries received a telemedicine visit, a lower proportion than in the Veterans Administration, in which 12% of beneficiaries receive some form of telehealth in a given year,” the authors observed.
“Proposed federal legislation would encourage greater use of telemedicine through expanded reimbursement. In contrast to others, we found that state laws that mandate commercial insurance reimbursement of telemedicine were not associated with faster growth in Medicare telemedicine use. Our results emphasize that nonreimbursement factors may be limiting growth of telemedicine including state licensure laws and restrictions that a patient must be hosted at a clinic or facility,” they write.