Substantial Boost in Virtual-Only Mental Health Treatment

TOPLINE:

In 2022, approximately 13% of mental health specialists switched to practicing exclusively via telemedicine, with rates highest among psychiatric nurse practitioners and clinicians working in densely populated areas, and with females more likely than males to switch, new research revealed.

METHODOLOGY:

• Researchers used health insurance claims from OptumLabs Data Warehouse for commercial insurance and Medicare Advantage enrollees for the years 2019 and 2022 after the start of the pandemic.
• They identified mental health specialists (psychiatrists, psychologists, social workers, and psychiatric mental health nurse practitioners [PMHNPs]) who had at least 30 visits and five patients in both years and conducted less than 25% of visits virtually in 2019.
• The study investigated the likelihood of providing “telemedicine-only” care in 2022, defined as conducting more than 95% of visits virtually.
• For each clinician, the study captured specialty, sex, region, age range of patient population, proportion of patients with severe mental illness, and median house value and population where most of their patients resided.

TAKEAWAY:

• Among 51,309 mental health specialists included in the analysis, 13.0% provided telemedicine-only care in 2022.
• The adjusted rate was highest among PMHNPs (18.7%; 95% CI, 17.1%-20.3%) and lowest among psychiatrists (9.1%; 95% CI, 8.6%-9.7%).
• Characteristics associated with a greater likelihood of switching to telemedicine only included being female (adjusted rate, 14.0% vs 11.1% for males; P P P
• Clinicians with a pediatric focus and those with an older adult focus (6.7%; 95% CI, 6.0%-7.5% and 6.5%; 95% CI, 5.6%-7.4%, respectively) were significantly less likely than general clinicians (14.1%; 95% CI, 13.8%-14.4%; P

IN PRACTICE:

It’s unclear how telemedicine-only clinicians will navigate Medicare and Medicaid changes, taking effect in 2025, that will require patients to get an annual in-person visit to continue receiving telemedicine visits for mental illness, the researchers wrote. They add that in-person requirements for visits and prescribing may “cause care interruptions, particularly for conditions such as opioid use disorder.”

SOURCE:

The study’s first author was Ruth Hailu, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. It was published online on January 26, 2024, as a Research Letter in the JAMA Health Forum.

LIMITATIONS:

As the analysis included only clinicians treating patients with commercial insurance or Medicare Advantage, results may not be generalizable. Researchers were unable to determine where clinicians physically practiced. Given the shortage of mental health clinicians, future research should explore whether a virtual-only model affects clinician burnout or workforce retention.

DISCLOSURES:

The study was supported by the National Institute of Mental Health. Hailu reported no relevant conflicts of interest. The disclosures of the other investigators can be found in the paper.