Disparities in telemedicine use and payment policies in the United States between 2019 and 2023.

Abstract

Background: The COVID-19 pandemic induced an increase in telemedicine use in the American health care system. We assess disparities in telemedicine usage, the diseases and conditions it is used for, and the association of payment parity policies with telemedicine use for January 2019-March 2023.

Methods: We include health systems which reported electronic health record data to the Healthjump database. The outcomes of interest are the percentage of outpatient consultations conducted via telemedicine in each health system and the distribution of outpatient and telemedicine consultations across 31 diseases and conditions. We use a difference-in-difference observational design to assess the association of state level payment parity mandates with telemedicine use.

Results: We show telemedicine use grew from less than 0.05% of outpatient consultations in 2019 to 25% in April 2020 and 4% in March 2023. Health systems in urban areas used telemedicine 2.4 times more than health systems in rural areas since April 2020 at the median. In March 2023, 29% of all mental health care visits and 21% of substance use disorder care were provided via telemedicine. Payment parity mandates are associated with a 2.5 percentage point increase in telemedicine use in the first quarter of 2023 compared to states without mandates.

Conclusions: The pandemic resulted in a sustained change in the use of telemedicine. The predominance of mental health care in telemedicine suggests that this mode of service delivery could be instrumental to increasing access to mental health services in the United States.