US: Use of telemedicine for mental health in rural areas on the rise but uneven

The study, by researchers at Harvard Medical School and the RAND Corporation, is based on an analysis of telemedicine use among Medicare beneficiaries nationwide over ten years.

This shows there was an average 45 percent jump per year in telemedicine visits between 2004 and 2014, among rural patients, with striking variation across states. Four states had no such visits in 2014, while in nine states, there were more than 25 telemedicine visits per 100 patients with serious mental illness.

The reasons for the dramatically uneven distribution remain unclear, but the study investigators say state laws that regulate the provision and reimbursement of telemedicine services for mental health appear to play some role.

“Our results highlight the growing importance of telemedicine in the treatment of mental health disorders in rural settings where access to mental health care is often problematic,” said study lead investigator Ateev Mehrotra, associate professor in the Department of Health Care Policy at Harvard Medical School.

Overall use of telemedicine services across all rural patients with mental health disorders remains extremely low, at 1.5 per cent.

In mental health, telemedicine is viewed as a particularly promising way to close the access gaps by providing remote video conferencing. Compared with other conditions, mental health disorders may be particularly well suited for telemedicine services as patients often do not need a physical exam.

There is an ongoing debate in Congress about the value of expanding telemedicine coverage for Medicare beneficiaries. Given that Medicare coverage standards often set the tone for services covered under commercial health plans, expanding access to telemedicine for Medicare patients could translate to expanding coverage for privately insured patients as well.

Some medical groups, including the Department of Veterans Affairs, have widely implemented telemedicine services, but Medicare has much more stringent criteria on which services can be reimbursed and a requirement that mandates that the patient and clinician must live in the same state.

“This work provides us with crucial information as we move forward to understand whether the rapid rise in mental telehealth actually translates into better patient outcomes,” said co-investigator Sherri Rose, associate professor of health care policy at Harvard Medical School.

“Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analysed Medicare fee-for-service claims for the period 2004–14 to understand trends in and recent use of telemedicine for mental health care. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemedicine health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemedicine 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.”

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