Study: Out-of-state telehealth restrictions could disrupt existing patient and provider relationships

JAMA Medical Forum published a cross-sectional study recommending a reimplementation that licensing restrictions on out-of-state telemedicine, which were lifted due to the COVID-19 pandemic, would have the most significant impact on with patients living near the state border, patients in rural areas, and those receiving primary care or mental health treatment.

The study’s authors write: “The easing of state restrictions will likely provide immediate convenience for patients living near the state border and those receiving primary care and treatment. mental health”. “These patients can have a geographic accident; two patients receiving the same care can have very different experiences. A patient with a primary care physician living in the central state can access the service. care through telemedicine. However, a similar patient living near the state border with a primary care physician in a neighboring state would now have to physically travel to that appointment.”


As COVID-19 emerged, many states temporarily allowed physicians to provide care in states where they did not have a license, thus allowing increased service delivery to people in areas with fewer medical facilities and resources.

The researchers aimed to identify which patients and specialties used out-of-state telemedicine visits among Medicare beneficiaries during COVID-19. They analyzed Medicare 100% fee-for-service (FFS) claims from January to June 2021.

This period was chosen because it was after the effects of the initial pandemic, when vaccines were available and the health care system stabilized but before temporary licensing regulations began to lapse.

The researchers note that in the first half of 2021, 8,392,092 patients were seen by a telemedicine provider, 5% of whom had one or more telemedicine visits with a telemedicine provider. out-of-state supply.

Patients living in a county near the state border accounted for 57.2% of all out-of-state telemedicine visits and 64.3% of those were with a primary care or health practitioner mental. In 62.6% of all out-of-state visits, prior in-person visits occurred between the same patient and healthcare provider.

Compared to patients with only in-state telehealth appointments, those accessing out-of-state care were more likely to qualify for Medicaid and live in rural areas.

The researchers note that there are limitations to their analysis, including focusing on the Medicare population and the assessment based on the patient’s home address and the physician’s practice address, which may not be correct. They also focused on patients who had telemedicine in and out of state, not patients who had telemedicine in general.

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