Female, Urban Providers More Likely to Shift to Telemental Health
Of the 13 percent of mental health specialists providing telehealth-only services in 2022, a higher proportion were female and worked in urban areas, per new research.
Female mental health specialists and those working in highly populated counties with higher real estate prices were more likely to shift their practice fully to telehealth in 2022 than their peers, according to new research.
Published in JAMA Health Forum, the research examines the number and characteristics of mental health specialists who shifted entirely to telehealth during the COVID-19 pandemic. One of the most popular use cases for telehealth is mental healthcare delivery. During the pandemic, telebehavioral healthcare services soared 45-fold, from 1 percent in 2019 to 33 percent in 2022, according to data from market research firm Trilliant Health.
For the new study, the research team conducted a cohort study using national, de-identified commercial health insurance claims from OptumLabs Data Warehouse. They included claims for commercial insurance and Medicare Advantage enrollees from January 1 to December 31, 2019, and January 1 to December 31, 2022.
The researchers identified 51,309 mental health specialists, including psychiatrists, psychologists, social workers, and psychiatric mental health nurse practitioners, who had at least 30 visits and five patients in 2019 and 2022 and conducted less than 25 percent of visits virtually in 2019. The clinicians defined a “telehealth-only” practice as conducting more than 95 percent of visits virtually.
Of the 51,309 mental health specialists included in the study, 13 percent had shifted to a telehealth-only practice in 2022. The rate of switching entirely to telehealth was highest among psychiatric mental health nurse practitioners and lowest among psychiatrists.
The researchers used multivariable models to determine the characteristics associated with a greater likelihood of switching to telehealth-only practices. They found that being female and working in counties in the top quartile of housing value and population was linked to higher odds of shifting to a telehealth-only practice than being male and working in low-density counties with low housing values.
Additionally, clinicians with a pediatric focus were less likely than general clinicians to have a telehealth-only practice.
“Given the shortage of mental health clinicians, future research should explore whether a virtual-only model affects clinician burnout or workforce retention,” researchers concluded.
They also noted that telehealth-only clinicians may face issues with regulatory requirements for telemental healthcare.
Currently, the Medicare program does not require an in-person visit within six months prior to an initial telemental health service and annually after that. However, this temporary flexibility is set to expire at the end of 2024.
Lawmakers are working to make this flexibility permanent. Last week, a group of bipartisan senators reintroduced the Telemental Health Care Access Act, which aims to remove the statutory requirement that Medicare beneficiaries be seen in person in the six months before receiving mental healthcare services through telehealth.
“Since the pandemic, we have seen how telehealth expanded health care access for those with substance use disorders, physical ailments, and mental health conditions. It has been an important lifeline for rural communities,” said Sen. Bill Cassidy, MD (R-LA), in the press release. “This bill removes barriers to allow Medicare patients to receive the telemental health services they deserve.”
There are also widespread health inequities that create barriers to telemental healthcare access.
A recent study showed that counties where mental health resources are low tend to also lack broadband internet access, hampering telehealth use. The researchers used data from the Federal Communications Commission (FCC), the National Neighborhood Data Archive, the National Center for Health Statistics, and the US Census Bureau’s American Community Survey.
They found that among US counties with low broadband access, 60.14 percent have no mental healthcare physicians, 73.81 percent have no non-physician mental health practitioners, 79.08 percent have no psychiatric and substance abuse hospitals, 84.62 percent lack inpatient psychiatric and substance abuse treatment facilities, and 30.01 percent lack outpatient facilities.
In a secondary analysis, researchers found that broadband access is likely lower in rural areas and/or areas with high poverty rates.