Receipt of Out-of-State Telemedicine Visits Among Medicare Beneficiaries During the COVID-19 Pandemic

This cross-sectional study examines out-of-state telemedicine use during the COVID-19 pandemic among Medicare beneficiaries. Question How was out-of-state telemedicine used during the COVID-19 pandemic? Findings In this cross-sectional study of telemedicine visits in the first half of 2021 among patients with Medicare, 422 547 patients had an out-of-state telemedicine visit; these visits were most common among those who lived near a state border and were largely for primary care and mental health treatment. In 62.6% of all out-of-state visits, a prior in-person visit occurred between the same patient and clinician. Meaning Limitations on out-of-state telemedicine care may disrupt many existing patient-clinician relationships in primary care and mental health treatment. Importance Early in the COVID-19 pandemic, states implemented temporary changes allowing physicians without a license in their state to provide care to their residents. There is an ongoing debate at both the federal and state levels on whether to change licensure rules permanently to facilitate out-of-state telemedicine use. Objective To describe out-of-state telemedicine use during the pandemic. Design, Setting, and Participants This cross-sectional study of telemedicine visits included all patients with traditional Medicare from January through June 2021. Main Outcomes and Measures Telemedicine visits from January through June 2021 where the patient's home address and the physician's practice address were in different states. Results In describing which patients and specialties were using out-of-state telemedicine, we focused on the period between January to June 2021. We chose this period because it was after the turmoil of the early pandemic, when vaccines became widely available and the health care system had stabilized, but before many of the temporary licensing regulations began to lapse by mid-2021. In the first half of 2021, there were 8 392 092 patients with a telemedicine visit and, of these, 422 547 (5.0%) had 1 or more out-of-state telemedicine visits. Those who lived in a county close to a state border (within 15 miles) accounted for 57.2% of all out-of-state telemedicine visits. Among the out-of-state visits in this time period, 64.3% were with a primary care or mental health clinician. For 62.6% of all out-of-state visits, a prior in-person visit occurred between the same patient and clinician between March 2019 and the visit. The demographics and conditions treated were similar for within-state and out-of-state telemedicine visits, with several notable exceptions. Among those with a telemedicine visit, people in rural communities were more likely to receive out-of-state telemedicine care (33.8% vs 21.0%), and there was high of out-of-state telemedicine use for cancer care (9.8% of all telemedicine visits for cancer care). Conclusions and Relevance The findings of this cross-sectional study suggest that licensure restrictions of out-of-state telemedicine would have had the largest effect on patients who lived near a state border, those in rural locales, and those who received primary care or mental health treatment.