Telemedicine surging in US but still uncommon

(Reuters Health) - Although telemedicine visits have increased sharply in the U.S. in recent years, the vast majority of American adults still receive care from doctors in person rather than via remote technology, a new study suggests.

The goal of telemedicine is to help improve access to specialty care, particularly in rural, underserved areas of the country, researchers note in JAMA. As of 2016, 32 states have passed so-called “parity” laws requiring insurance coverage and reimbursement for telemedicine visits.

To see whether these laws translate to more use of telemedicine, researchers examined private health insurance claims data from 2005 to 2017 from OptumLabs Data Warehouse.

Overall, annual telemedicine visits increased from 206 visits in 2005, or less than one per 1,000 people in the study, to more than 202,000 visits in 2017, or more than seven per 1,000. Most of this increase happened over the last few years of the study, with an average annual compound growth rate of 52 percent from 2005 to 2014 and an annual average compound growth rate of 261 percent from 2015 to 2017.

“If the growth rates we are observing continue, in a decade telemedicine will be seen as quite common,” said lead study author Dr. Michael Barnett of the Harvard T. H. Chan School of Public and Brigham and Women’s Hospital in Boston.

At this point, telemedicine is still rare. It’s growing most rapidly in areas where a shortage of mental health specialists is prompting more patients to consider this alternative to in-person visits, Barnett said by email.

During the study period, 53 percent of telemedicine visits were for mental health visits, followed by primary care exams at 39 percent. By the final year of the study, primary care was the most common form of telemedicine.

From 2015 to 2017, telemedicine users in the study were 38 years old on average. Roughly 83 percent lived in rural areas.

While more people used telemedicine in states with laws requiring insurance coverage for these visits, the study wasn’t designed to prove whether or how state laws might directly impact adoption of telemedicine.

It’s also possible that the study underestimated how many people used telemedicine for care because it only counted visits covered by insurance, said Dr. Jeffrey Linder, a researcher at the Northwestern University Feinberg School of Medicine in Chicago who wasn’t involved in the study.

“It does not capture telemedicine visits for which there was not an insurance claim,” Linder said by email. “Patients could have paid out of pocket or, perhaps just as likely, the physician did not think or go to the trouble of submitting an insurance claim.”

Still, the results suggest that parity laws may help solve reimbursement issues that remain a major hurdle to widespread adoption of telemedicine, said Dr. Todd Mahr of Gundersen Health System in La Crosse, Wisconsin.

“It is very exciting that in the last year, primary care visits increased dramatically due to improved coverage,” Mahr, who wasn’t involved in the study, said by email. “Hopefully there will be continued improvement in parity laws to bolster this trend.”

Patients seen by telemedicine are generally satisfied with their care, and telemedicine will continue to become more common as it becomes easier for clinicians to be paid for this type of exam, said Dr. Jay Portnoy of Children’s Mercy - Kansas City and the University of Missouri Kansas City School of Medicine.

“Direct-to-consumer telemedicine is exploding since it is so easy to set up (patients can be seen at home),” Portnoy, who wasn’t involved in the study, said by email.

“The limitation is that there is no physical exam and payment options are limited (mostly to fee-for-service),” Portnoy added. “Facilitated visits (which replace in-person visits) are more difficult since there needs to be a facility to do a physical exam and a facilitator where the patient is located.”

SOURCE: JAMA, online November 27, 2018.