At both the federal and state levels, there is a growing interest in telemedicine. But how is it working? Ateev Mehrotra and his team studied the use of mental health telemedicine in rural areas for people with Medicare with either mental illness or serious mental illness over the ten-year period between 2004 and 2014. They found that telemedicine is serving a small cohort of vulnerable people with mental illness, largely people with disabilities living in poor communities.
There has always been an unmet need for mental health care. At the beginning of the 21st century, fewer than one in three people with a mental illness received care. And, fewer than one in two people with a serious mental illness received care.
People with mental illnesses in rural communities are most likely to go without care because of the lack of mental health providers. Telemental health can meet their need because mental health providers do not need to be based nearby. It provides for care through live video teleconference. And, it has been shown to work particularly well for people with depression and schizophrenia.
To help address the unmet need for mental health care, Medicare covers telehealth via live videoconference for people living in rural communities, so long as it takes place at a health clinic or hospital and the health care provider is licensed in the state in which the patient lives. But, Congress has been reluctant to expand the benefit for fear that it will drive up Medicare costs significantly.
The researchers found that, in 2014, Medicare covered telehealth services for 1.5 percent of people with mental illness and 3.7 percent with serious mental illness in rural communities. More than 85 percent of them also received in-person mental health care. Many suffered from depression or bipolar disorder. Most of them were under 65 with a disability and lived in poorer communities.
The researchers also found a huge rise in the use of telehealth services between 2004 and 2014, growing from one in 500 people using the services in 2004 to more than 25 in 500 in 2014. But, the state people lived in affected the rate of usage. Different states have different laws regarding telehealth services.
For example, no one with mental illness in rural Connecticut, Delaware and Rhode Island received Medicare-covered telehealth services. Whereas, one in ten people with mental illness in rural Iowa and South Dakota received services.
In rural Nevada and Wyoming, there were 45 visits for every 100 people with serious mental illness. In seven other states, there were more than 25 visits for every 100 people with serious mental illness.
The researchers did not study whether Medicare-covered telehealth services were improving access to care and health outcomes.
Here’s more from Just Care:
- PACE (Program of all-inclusive care for the elderly) helps older adults stay in their community
- Telehealth on the rise
- Three things to think about when getting mental health care if you have Medicare
- Half a million people with low incomes unable to get mental health care in states that have not expanded Medicaid
- Four things to know if your income is low and you have Medicare