O-43 Did Telemedicine Adoption Increase the Geographic Reach of Mental Health Specialists?

Methods: This cohort study analyzed 100% Medicare feefor-service claims data from 2018 to 2023. Mental health specialists (psychiatrists, psychologists, social workers, and psychiatric nurse practitioners) were categorized into four groups by telemedicine use in 2021: lowest (0-40%), lowmid (41-79%), mid-high (80-98%), and highest (99-100%). Linear regression models estimated yearly differential changes between higher and lower telemedicine specialists. Patient location was fixed to their first recorded address to isolate the effect of moving versus new patients.

Results: The cohort included 17,742 mental health specialists, mostly in solo practices (61.9%) and urban areas (90.5%). Specialists in the highest telemedicine group (n=4,581) had more visits with rural patients (12.6% increase; 95% CI 7.6, 17.5), out-of-state patients (26.3 %increase; 95% CI 16.7, 35.9), and patients ≥20 miles away (19.8% increase; 95% CI 14.8, 25.0) compared to those in the lowest telemedicine group (n=4,586). However, changes for patients in mental health specialist-shortage areas were not significant (6.81% increase; 95% CI -7.33, 20.9). Over two-thirds of the increase in out-of-state visits and nearly half of the increase in visits for patients residing ≥20 miles away were due to established patients moving, not new patients entering practice. Additionally, specialists with the highest telemedicine use saw fewer new patients post-pandemic.

Conclusion: Telemedicine adoption among mental health specialists increased geographic reach, primarily by retaining established patients who moved, rather than expanding access to new patients in rural and underserved communities. Policy interventions should incentivize telemedicine use in these communities and encourage specialists to take on new patients.