Hailu, R., Huskamp, H. A., et al. (2024).
JAMA, 5(1), e234982.
Introduction
The COVID-19 pandemic–related shift to telemedicine has been particularly prominent and sustained in mental health care. In 2021, more than one-third of mental health visits were conducted via telemedicine. While most mental health specialists have in-person and telemedicine visits, some have transitioned to fully virtual practice, perhaps for greater work-life flexibility (including avoiding commuting) and eliminating expenses of maintaining a physical clinic. The decision by some clinicians to practice only via telemedicine has gained importance due to Medicare’s upcoming requirement, effective in 2025, that patients have an annual in-person visit to receive telemedicine visits for mental illness and new requirements from some state Medicaid programs that clinicians offer in-person visits. We assessed the number and characteristics of mental health specialists who have shifted fully to telemedicine.
Discussion
In 2022, 13.0% of mental health specialists serving commercially insured or Medicare Advantage
enrollees had shifted to telemedicine only. Rates were higher among female clinicians and those
working in densely populated counties with higher real estate prices. A virtual-only practice allowing
clinicians to work from home may be more attractive to female clinicians, who report spending more
time on familial responsibilities, and those facing long commutes and higher office-space costs.
It is unclear how telemedicine-only clinicians will navigate new Medicare and Medicaid
requirements for in-person care. While clinicians and patients may prefer in-person care,
introducing in-person requirements for visits and prescribing could cause care interruptions,
particularly for conditions such as opioid use disorder.
Our analysis is limited to clinicians treating patients with commercial insurance or Medicare
Advantage and therefore may lack generalizability. We were also unable to determine where
clinicians physically practiced, particularly if they had transitioned to virtual-health companies. Given the shortage of mental health clinicians, future research should explore whether a virtual-only model
affects clinician burnout or workforce retention.
