Study: Limiting Out-of-State Telehealth Could Disrupt Existing Patient-Provider Relationships


JAMA Health Forum published a cross-sectional study suggesting re-enforcement that out-of-state telemedicine licensing restrictions, which were lifted due to the COVID-19 pandemic, would have the most significant effect on patients living near a state line, those in rural areas, and those receiving primary care or mental health treatment.

“Easing state restrictions would likely provide immediate convenience to patients who live near a state line and to those receiving primary care and mental health treatment,” the authors wrote. study. “These patients are subject to an accident of geography; two patients receiving the same care can have very different experiences. A patient with a primary care physician who lives in the middle of a state can access care via telemedicine. However, a similar patient living near a state line with a primary care physician in the neighboring state will now have to physically travel to that appointment.”


When COVID-19 emerged, many states temporarily allowed physicians to provide care in states in which they were unlicensed, allowing for increased availability of providers for those in areas with fewer medical facilities and resources.

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

This period was chosen because it is after the impact of the first pandemic, when vaccines were available and the healthcare system stabilized, but before temporary licensing regulations began to expire.

The researchers noted that in the first half of 2021, 8,392,092 patients had been seen by a provider via telemedicine, of which 5% had had one or more telemedicine visits with an out-of-state provider.

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

Compared to patients who only had in-state telehealth appointments, those who accessed out-of-state care were more likely to be dual-eligible for Medicaid and live in rural areas.

The researchers note that there are limitations to their analysis, including its focus on the Medicare population and its assessment based on the patient’s home address and clinician’s office address, which may be inaccurate. They also focused on patients who had in-state and out-of-state telemedicine visits, not those who had telemedicine visits in general.

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