Telemedicine Use Increasing, Parallels Growth of Parity Laws

Norra MacReady

November 27, 2018

Patients' use of telemedicine has grown rapidly since 2005, new data show. However, use of telemedicine overall is still relatively uncommon and often may be influenced more by a desire for convenience than a dearth of clinicians.

The leap in telemedicine visits was especially dramatic between 2015 and 2017, coinciding with the establishment of parity laws requiring coverage of direct-to-consumer telemedicine care, which had passed in 32 states as of 2016, Michael L. Barnett, MD, and colleagues write in an article published online today in JAMA. The greatest increases were seen in mental health and primary care.

Barnett, of the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues analyzed data from a claims database for privately insured and Medicare Advantage enrollees to study trends in telemedicine use between 2005 to 2017. Overall, there were 383,565 telemedicine visits by 217,851 patients.

In 2005, there were 206 annual telemedicine visits among all participants (0.020 per 1000 members; 95% CI, 0.018 - 0.021), but by 2017 this had increased to 202,374 (6.57 per 1000 members; 95% CI, 6.54 - 6.60). This translates into an average annual compound growth rate of 43% from 2005 to 2014 and 261% from 2015 to 2017. Mental health and primary care telemedicine accounted for 53% and 39% of the visits, respectively.

Telemedicine patients from 2015 to 2017 were a mean age of 38.3 years, 63.0% were female, and 83.3% resided in urban areas, the authors add. Users of primary care telemedicine were slightly younger than users of mental health telemedicine services and more likely to live in cities.

These findings contradict one of the selling points of telemedicine, which has been its potential for bringing care to rural dwellers living in regions where physicians might be scarce, Barnett and colleagues write. Although use of mental health visits increased most rapidly in counties with no psychiatrists (P < .001 for interaction), "growth of primary care telemedicine was not associated with primary care physician supply (P = .76 for interaction), and there was a small negative association with comprehensive parity laws (P = .04 for interaction)."

These findings suggest that although clinician supply may have influenced patients' use of telemental health, convenience may have been a greater factor among consumers of primary care telemedicine, the authors conclude.

One important study limitation was the use of data from a single insurer; enrollees who were younger and more heavily concentrated in the South than the general United States population, they write.

The authors have disclosed no relevant financial relationships.

JAMA. 2018;320:2147-2149. Abstract

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