Out-of-State Telehealth Aided Rural Residents Amid the Pandemic

A study published in JAMA Health Forum found that many Medicare beneficiaries benefitted from the elimination of restrictions on out-of-state telehealth services during the COVID-19 pandemic, primarily those with cancer, rural residents, and those residing nearby state borders.

According to the Centers for Disease Control and Prevention, 95 percent of health centers used telehealth during the COVID-19 pandemic. This sharp uptake has prompted researchers to explore the effects of telehealth and the populations that use it the most.

This study examined out-of-state telehealth data from January to June 2021. They selected this time period because it followed the abrupt onset of the pandemic and included vaccine distribution efforts.

Further, state-based licensing flexibilities were still in effect during the study period, enabling out-of-state telemedicine. Most flexibilities were eliminated by mid-2021, after which pre-pandemic state licensing laws were reinstated.

Overall, 8.3 million Medicare beneficiaries participated in a telehealth visit between January and June 2021. Of these, 422,547 (5 percent) had one or more out-of-state telehealth visits.

Through geographical analysis, researchers determined that 57.2 percent of all out-of-state telehealth visits involved patients who lived near a state border, defined as within 15 miles of a border.

Upon analyzing out-of-state visits, researchers found that 64.3 percent included a primary care or mental health clinician, and 62.6 percent were preceded by an in-person visit between March 2019 and the telehealth visit involving the same patient and provider.

Researchers also found that rural residents were more likely to receive telehealth from an out-of-state location, with 33.8 percent of out-of-state visits involving a rural resident versus 21 percent of within-state telemedicine visits. Also, 9.8 percent of out-of-state telehealth visits were for cancer care, the highest rate among all specialties.

Based on this data, researchers concluded that Medicare beneficiaries living in rural areas, seeking cancer care, and living nearby state borders were the most likely to obtain telehealth from an out-of-state clinician. The study results also imply that these populations are highly affected by restrictions that limit out-of-state telehealth.

Researchers noted a few limitations within their study, including the potential bias associated with data from the traditional Medicare population and the use of home addresses to determine the state in which a patient resides.

Various studies have collected data that reveal the difficulties some patients may face when obtaining care.

Highlighting the care disparities between urban and rural residents, research from June found that Native American patients often faced difficulties when accessing cancer care. This was largely due to the large geographic distance between the areas in which American Indian and Alaska Native patients reside and the locations of clinics.

Due to the high prevalence of access disparities, organizations often push for regulatory expansions related to telehealth. In September, 375 stakeholders signed a letter sent to the US Senate that requested the solidification of telehealth access for two years after the COVID-19 public health emergency has ended.