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Health Affairs: Telemental Health Visits Growing Rapidly Among Rural Beneficiaries

May 9, 2017
by Rajiv Leventhal
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Between 2004 and 2014, the number of “telemental” health visits among rural beneficiaries grew on average 45 percent annually, according to new research published in May Health Affairs.

For the study, researchers analyzed Medicare fee-for-service claims for the period 2004 to 2014 to understand trends in and recent use of telemedicine for mental health care, or telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness.

Indeed, the results showed that the number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was also notable variation across states: In 2014, nine states had more than 25 visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. And, compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than 65 years old, be eligible for Medicare because of disability, and live in a relatively poor community. Also, states with a telemedicine parity law and a pro–telemental health regulatory environment had significantly higher rates of telemental health use than those that did not.

The researchers said that compared to other conditions, mental health conditions may be particularly well suited to telemedicine, given that visits frequently do not involve a physical exam. Using telemental health to assess and treat patients with mental illness has been demonstrated to be comparable or even superior to in-person care in various studies, they stated.

Nonetheless, the study’s authors noted that Medicare has taken a cautious approach to reimbursement for telemedicine. Current Medicare regulations provide coverage only for those living in rural areas, and they mandate that the interaction occur via live videoconference. In addition, the patient must be hosted at a clinic or facility such as a hospital in a rural region, and not be at home or the workplace. In 2015 Medicare created a limited exception for urban patients who are cared for by certain accountable care organizations (ACOs). Medicare also limits what types of care can be provided by telemedicine—though currently this set of reimbursable care includes almost all mental health encounters, such as consultations, office visits, psychotherapy, and psychopharmacologic management

Of all rural Medicare beneficiaries in 2014, some 1.6 million (14.5 percent) had a mental health diagnosis, and more than 400,000 (3.7 percent) had a diagnosis of a serious mental illness. In 2014, 1.5 percent of rural beneficiaries diagnosed with any mental illness and 3.7 percent of those diagnosed with serious mental illness received a telemental health visit, according to the research.

Meanwhile, in the 10-year span that this research covered, the number of telemental health visits among rural patients with any mental illness rose from 2,365 to 87,120 visits, while the number of visits among those with serious mental illness rose from 1,040 to 50,050. Among all rural Medicare beneficiaries with a mental illness, there were 5.3 telemental health visits per 100 beneficiaries in 2014, compared to 0.2 telemental health visit per 100 beneficiaries in 2004.

The researchers noted in their conclusion, “Telemental health has been promoted as a way to extend mental health specialist care to patients without access to such care in their community, but we found that a relatively small fraction (less than 15 percent) of rural telemental health recipients received mental health specialty care only via telemental health. Thus, telemental health appears to be complementing and supplementing in-person care. While this may improve the care these patients receive, telemental health use does not appear to be greatly expanding the number of rural beneficiaries who receive any mental health specialty care.”

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