Although telemedicine visits among Medicare beneficiaries have increased by 28 percent annually for a decade’s time, in 2013, less than 1 percent of rural Medicare beneficiaries actually received a telemedicine visit, a lower proportion than in the Veterans Administration (VA).
Disabled patients in rural areas made up about half of the visits, according to the new research published in the Journal of the American Medical Association (JAMA). While telemedicine might increase access to care and improve quality, inadequate reimbursement may limit its use, the researchers found. In the U.S., 29 states have passed telemedicine parity laws mandating that commercial insurers reimburse telemedicine visits. However, Medicare limits telemedicine reimbursement to select live video encounters with a patient at a clinic or facility in a rural area. Indeed, federal legislation has been proposed to expand telemedicine coverage.
Using claims from a 20 percent random sample of traditional Medicare beneficiaries, the researchers found that virtual visits increased from just over 7,000 in 2004 to nearly 108,000 in 2013. Most of these visits occurred in outpatient clinics; 12.5 percent occurred in a hospital or skilled nursing facility. Mental health conditions were responsible for nearly eight in 10 such visits.
Rural beneficiaries who did receive a 2013 telemedicine visit were more likely to be younger than 65 years old, have entered Medicare due to disability, have more comorbidities, and live in a poorer community compared with those who did not receive a telemedicine visit.
What’s more, telemedicine utilization in 2013 was higher in the 12 states with parity laws as of 2011. "Proposed federal legislation would encourage greater use of telemedicine through expanded reimbursement. In contrast to others, we found that state laws that mandate commercial insurance reimbursement of telemedicine were not associated with faster growth in Medicare telemedicine use. Our results emphasize that non-reimbursement factors may be limiting growth of telemedicine including state licensure laws and restrictions that a patient must be hosted at a clinic or facility," the authors wrote.