Growth, and Limitations, for Rural Tele-Mental Health

May marks Mental Health Awareness Month, making it a fitting time for the release of a new study on the utilization of telemedicine among rural Medicare beneficiaries for mental health services. Published in the most recent edition of Health Affairs, the study from researchers at Harvard Medical School and RAND uncovered strong growth in utilization of telemedicine in this patient population, along with significant differences in usage from state to state. As lead researcher Ateev Mehrotra, of Harvard, put it, “Our results highlight the growing importance of telemedicine in the treatment of mental health disorders in rural settings where access to mental health care is often problematic.”

Looking more closely at the results, the researchers, who examined a decade’s worth of data from Medicare claims, found an overall 45 percent increase each year in telemedicine visits to treat mental health conditions. Among rural patients who were classified as having serious mental illnesses, there was particularly significant utilization; as the researchers note, 12 out of 100 of these patients had had a telemedicine visit. The visits, however, were not evenly distributed among states; although “in nine states, there were more than 25 telemedicine visits per 100 patients with serious mental illness,” four states reported that patients there had had no such encounters. And overall utilization is still not particularly high: only 1.5 percent of all patients with mental health conditions residing in rural areas, per the researchers, had been treated via telemedicine.

What were the reasons behind such significant differences among states, and still-limited utilization? The study’s authors point in part to state-level regulatory conditions, as well as Medicare’s restrictions on telemedicine services. “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 explained. Notably, the Harvard/RAND study is not the first in recent months to highlight the ways in which Medicare may be holding telemedicine back. As we noted last month, the recent Government Accountability Office (GAO) report to Congress on telemedicine utilization suggested that outdated Medicare reimbursement policies and other coverage limitations are standing in the way of wider utilization. Representatives from provider groups interviewed for the study “reported that both telehealth and remote patient monitoring may improve or maintain quality of care in Medicare, but they rated concerns regarding payment and coverage restrictions as potential barriers,” GAO researchers noted.

Click here for the announcement of the study publication from Harvard Medical School.

Click here for the full study results from Health Affairs (abstract is free; full article requires payment).


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