43% of mental health visits occurred via telehealth in 2021

New data reveals that in 2021, 43.2 percent of psychiatrist visits occurred via telehealth versus 4.5 percent of visits to other physicians, highlighting telemental healthcare’s enduring popularity after the peak of the COVID-19 pandemic.

Published in the Annals of Internal Medicine, the study examined telehealth use in 2021 when in-person care had resumed following restrictions in 2020. Researchers from the United States Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) conducted the assessment using the 2021 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the civilian population and clinicians.

The survey respondents were asked about healthcare they had received via real-time telehealth interactions by phone or video. The survey did not count communication via e-mail, patient portal, or voice message as telehealth.

The researchers analyzed a study sample of 232,024 visits, of which 9.6 percent were conducted via telehealth.  

According to study findings, telehealth use varies widely across clinician types. For instance, 43.2 percent of visits to psychiatrists occurred via telehealth, compared to 4.5 percent of visits to other physicians. Outside of the mental healthcare arena, non-physicians conducted about 11.4 percent of visits via telehealth, compared to physicians who conducted 4.5 percent of visits through telehealth.

Additionally, in 2021, primary care clinicians conducted 6.1 percent of visits via telehealth, compared with 3.5 percent conducted by specialty care physicians. Non-surgical physicians conducted 4.8 percent of visits virtually, compared with 1.3 percent performed by surgical specialists.

However, the percentage of telehealth visits decreased throughout 2021 across all clinician categories. The percentage of telehealth visits declined by 44 percent to 49 percent for non-mental health visits and by 18 percent to 19 percent for mental health visits. This suggests “that use of telehealth after the PHE [public health emergency] peak has returned closer to pre-PHE levels for non–mental health clinicians,” the researchers wrote.

“Future studies weighing costs and benefits are needed to inform the appropriateness of policy initiatives to encourage telehealth and improve access among patients less likely to use telehealth, including those in rural areas and those who are older or less educated,” they concluded.

The study comes amid intensifying discussions around telehealth policy’s future.

Pandemic-era telehealth flexibilities will expire at the end of 2024. These include waivers eliminating geographic restrictions on originating sites for telehealth services, allowing federally qualified health centers and rural health centers to continue providing telehealth services, and lifting the initial in-person care requirements for those receiving mental healthcare through telehealth.

Lawmakers have been soliciting information from medical experts on telehealth-related benefits and challenges. In April, the House Energy and Commerce Committee’s Subcommittee on Health conducted a hearing to discuss 15 legislative proposals currently in front of Congress that aim to support patient access to telehealth.

Though the witnesses invited to testify agreed that telehealth is a critical aspect of healthcare delivery and that curbing access would negatively affect Americans, there were nuanced conversations around telehealth quality and reimbursement.

For instance, Ateev Mehrotra, MD, professor of healthcare policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, argued that paying less for telehealth services may be better than telehealth payment parity, wherein payers reimburse for telehealth services at the same rate as the equivalent in-person services.

“Because we don't want to create distortions in the market where we're encouraging clinicians to give up their physical practice because they don't have to pay the rent, et cetera,” he said during the hearing.

Following this hearing by the health subcommittee, the Ways and Means Committee advanced legislation that extends the pandemic-era waivers through 2026.