Telemental health service availability declined post-PHE

Telemental healthcare service availability has declined since the end of the COVID-19 public health emergency (PHE), with only 79 percent of mental health treatment facilities offering telehealth after May 2023 compared to 81 percent before then, new research shows.

Published in JAMA Network Open, the study assessed changes in telehealth services offered at outpatient mental health treatment facilities during and after the COVID-19 PHE. The PHE played a significant role in boosting telemental healthcare adoption, with policies temporarily enabling mental health professionals to provide telehealth services without a prior in-person examination, allowing Medicare reimbursement for various telehealth services, and approving reimbursement for audio-only telehealth. However, several of these flexibilities expired with the end of the PHE on May 11, 2023, with others slated to expire at the end of 2024.

Researchers from Rand Corp., Brigham and Women’s Hospital, and Georgetown University’s School of Medicine conducted a national secret shopper analysis, comparing mental health treatment facilities’ responses about telehealth availability before and after the PHE was declared over.

They contacted mental health treatment facilities in two waves. The first wave lasted from December 2022 to March 2023, while the second wave lasted from September to November 2023. During the first wave, the callers posed as prospective clients, contacting a random sample of 1,404 facilities drawn from the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Locator. They contacted the same facilities in the second wave.

Of the 1,404 facilities contacted, 713 (71.2 percent) were located in metropolitan counties, 638 (63.7 percent) were private nonprofit, 212 (21.2 percent) were private for-profit, and 151 (15.1 percent) were public facilities. A total of 935 (93.4 percent) accepted Medicaid.

The researchers found that the overall availability of telehealth declined from 799 facilities (81.6 percent) in the first wave to 765 (79 percent) in the second wave. Additionally, the availability of audio-only telehealth declined from 369 facilities (49.3 percent) to 244 (34.1 percent), and the availability of telehealth for comorbid mental health and alcohol use disorder (AUD) declined from 559 facilities (76.3 percent) to 457 (66.5 percent) between the waves.

The researchers further categorized the mental health treatment facilities into four classes: sustainers (facilities that offered telehealth in both waves), late adopters (facilities that did not offer telehealth in the first wave but did in the second), nonadopters (facilities that did not offer telehealth in either wave), and discontinuers (facilities that offered telehealth in the first wave but not in the second).

Around 72 percent of facilities were in the sustainer class, 11.2 percent were in the nonadopter class, 9.9 percent were in the discontinuer class, and 7 percent were in the late adopter class.

The study shows that ownership was significantly associated with a facility's class. For example, private for-profit facilities had 72 percent lower odds of being a discontinuer and 53.5 percent lower odds of being a nonadopter than publicly owned facilities.

Similarly, private nonprofit facilities were 73.8 percent less likely to be a discontinuer and 73.7 percent less likely to be a nonadopter than public facilities.

Overall, private mental health treatment facilities were more likely to be sustainers (69.9 percent) compared to public facilities (53.2 percent).

“Our results emphasize the importance of monitoring access to mental health care in a postpandemic era, especially against the backdrop of the federal and state policy landscape,” the researchers concluded.

Mental healthcare remains one of the top use cases for telehealth. Data released by Epic Research in December 2023 revealed that telemental health utilization dropped from 65.5 percent in the second quarter (Q2) of 2020 to 37 percent in the third quarter (Q3) of 2023.

However, this percentage is still far higher than that of telehealth use in other specialties. In Q3 2023, infectious disease (11 percent), obstetrics (10 percent), and transplant (10 percent) trailed behind mental health as the specialties with the highest telehealth utilization rates.