Virtual mental health visits show little impact on rural care access

During the COVID-19 pandemic, mental health specialists started using telemedicine much more frequently. Despite many benefits, a new study finds that virtual visits did not make it easier for psychiatrists, psychologists and therapists to reach significantly more people in areas where access to care has long been limited.

By analyzing Medicare billing records from providers practicing across the country, researchers from the Brown University School of Public Health, Harvard Medical School and McLean Hospital showed that greater use of telemedicine among mental health specialists did not substantially change whether they were seeing patients from rural or underserved areas.

According to data published in JAMA Network Open, mental health specialists who used telemedicine the most treated only slightly more patients from rural and underserved areas compared with specialists who used it far less.

"We had thought the dramatic shift from in-person care to telemedicine among mental health specialists would lead to them caring for substantially more patients in rural communities," said study author Drew Wilcock, a lead research scientist at Brown's School of Public Health. "Unfortunately, we just don't see it."

The team looked at Medicare billing records from 2018 to 2023 for 17,742 mental health specialists and grouped them into categories based on how much they used telemedicine to deliver care.

They found that compared with specialists who used telemedicine less, those who used telemedicine heavily only saw about 0.9 percentage points more rural patients, 0.1 percentage points more patients from areas that lack reliable access to mental health care providers, and 2.6 percentage points more patients located 20 miles or more from the provider. Researchers also found that those modest increases primarily reflected existing patients who moved to areas far from their providers and continued care via telemedicine.

The results also highlighted an unintended consequence of telemedicine use. Specialists using telemedicine more actually saw 3.6 percentage points fewer new patients overall. That finding suggests that while telemedicine may help specialists maintain long-term relationships with existing patients, it can reduce their capacity to take on new patients at the same time.

The researchers highlighted policy changes that could ensure telemedicine reaches the communities that need it most.

Currently, it is too administratively burdensome for a mental health physicians to get a license in many states. By changing how states license clinicians and making it easier for them to practice across state lines, this could help specialists reach more patients in rural communities."

Jacob Jorem, lead study author, Harvard Medical School

The researchers hope the findings prompt action from legislators and practitioners.

"The potential of telemedicine can't be ignored," said study author Ateev Mehrotra, a professor of health services, policy and practice at Brown. "But simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care. For telemedicine's potential to be reached, we need policy interventions to address those barriers. Improving how we license physicians is a critical first step."