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.
Dr. Mehrotra tells Reuters Health by email, “There is ongoing debate on whether to expand telemedicine in the Medicare program. Our results highlight that the targeted and cautious approach by Medicare to date has reached sicker, rural, and relatively poorer beneficiaries with mental illness. Arguably, the population with the most dire access issues is benefiting most from telemedicine.”
“Because widespread expansion of telemedicine would raise concerns about overuse, I advocate that Medicare expand access to telemedicine but still limit [its use] to clinical settings where the patient population more often has difficulty accessing care [in settings] such as community health centers,” he says.
Dr. Gary C. Doolittle, interim director of clinical oncology at the University of Kansas Hospital in Kansas City, told Reuters Health by email, “We’ve been using telemedicine since 1994 and (its) growth is very positive. Telemedicine is extremely important for us as we serve many rural patients in Kansas.”
“For example, tablets are provided to hospice patients so that they and their caregivers can video conference with hospice specialists and regularly check in on patient health and address any questions or needs. Also, hospital specialists are available remotely to provide second opinions with cancer diagnoses. Instead of patients driving six hours to the see the doctor, they can video conference from home and interact with specialists at the hospital’s cancer center in real time,” Dr. Doolittle says. “We need to make sure that policies support this initiative.”
Melvin Hall and CHSi Corporation funded this research. The authors reported no disclosures.