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 The goal of telemedicine is to help improve access to specialty
care, particularly in rural, underserved areas of the country,
researchers note in JAMA. As of 2016, 32 states have passed
so-called "parity" laws requiring insurance coverage and
reimbursement for telemedicine visits.
To see whether these laws translate to more use of telemedicine,
researchers examined private health insurance claims data from 2005
to 2017 from OptumLabs Data Warehouse.
Overall, annual telemedicine visits increased from 206 visits in
2005, or less than one per 1,000 people in the study, to more than
202,000 visits in 2017, or more than seven per 1,000. Most of this
increase happened over the last few years of the study, with an
average annual compound growth rate of 52 percent from 2005 to 2014
and an annual average compound growth rate of 261 percent from 2015
to 2017.
"If the growth rates we are observing continue, in a decade
telemedicine will be seen as quite common," said lead study author
Dr. Michael Barnett of the Harvard T. H. Chan School of Public and
Brigham and Women's Hospital in Boston.
At this point, telemedicine is still rare. It's growing most rapidly
in areas where a shortage of mental health specialists is prompting
more patients to consider this alternative to in-person visits,
Barnett said by email.
During the study period, 53 percent of telemedicine visits were for
mental health visits, followed by primary care exams at 39 percent.
By the final year of the study, primary care was the most common
form of telemedicine.
From 2015 to 2017, telemedicine users in the study were 38 years old
on average. Roughly 83 percent lived in rural areas.
While more people used telemedicine in states with laws requiring
insurance coverage for these visits, the study wasn't designed to
prove whether or how state laws might directly impact adoption of
telemedicine.
It's also possible that the study underestimated how many people
used telemedicine for care because it only counted visits covered by
insurance, said Dr. Jeffrey Linder, a researcher at the Northwestern
University Feinberg School of Medicine in Chicago who wasn't
involved in the study.
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"It does not capture telemedicine visits for which there was not an
insurance claim," Linder said by email. "Patients could have paid
out of pocket or, perhaps just as likely, the physician did not
think or go to the trouble of submitting an insurance claim."
Still, the results suggest that parity laws may help solve
reimbursement issues that remain a major hurdle to widespread
adoption of telemedicine, said Dr. Todd Mahr of Gundersen Health
System in La Crosse, Wisconsin.
"It is very exciting that in the last year, primary care visits
increased dramatically due to improved coverage," Mahr, who wasn't
involved in the study, said by email. "Hopefully there will be
continued improvement in parity laws to bolster this trend."
Patients seen by telemedicine are generally satisfied with their
care, and telemedicine will continue to become more common as it
becomes easier for clinicians to be paid for this type of exam, said
Dr. Jay Portnoy of Children's Mercy - Kansas City and the University
of Missouri Kansas City School of Medicine.
"Direct-to-consumer telemedicine is exploding since it is so easy to
set up (patients can be seen at home)," Portnoy, who wasn't involved
in the study, said by email.
"The limitation is that there is no physical exam and payment
options are limited (mostly to fee-for-service)," Portnoy added.
"Facilitated visits (which replace in-person visits) are more
difficult since there needs to be a facility to do a physical exam
and a facilitator where the patient is located."
SOURCE: http://bit.ly/2TPSKbd JAMA, online November 27, 2018.
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