Study spotlights trends in interstate telehealth as policymakers decide on path forward

The explosion in the use of telehealth during the COVID-19 pandemic and was fueled in part by temporary rules giving physicians and patients flexibility to connect across state lines by telephone or online.

Many of these temporary rules have expired or will expire soon, and the authors of a recently published study1 hope their research in trends in use interstate telehealth will help inform policymakers as they decide on permanent state licensure rules for telehealth visits.

“With patients and providers now much more used to telehealth than they were two years ago, and with interstate licensure waivers expired or expected to expire soon, the question of how to design longer-term licensure policies to facilitate interstate telehealth is urgent,” senior study author Chad Ellimoottil, MD, MS, an assistant professor of Urology at Michigan Medicine and director of IHPI’s Telehealth Research Incubator lab stated in the news release.2 “Each state should prioritize this issue based on patterns of care among their residents.”

The study, “Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017-20,” was published in Health Affairs. Researchers from the University of Michigan’s Institute for Healthcare Policy and Innovation (IHPI) examined data from older adults covered by traditional Medicare before and during the first year of the COVID-19 pandemic.

“Prior to the pandemic, state licensure rules hindered telehealth,” study first author Juan Andino, MD, MBA, said in the news release. Before the pandemic, state licensure rules limited telehealth to patients who in the state where clinicians were licensed to practice medicine. Clinicians can seek licensure in multiple states but must meet each state’s requirements to achieve and maintain their license.

During the pandemic, all 50 states allowed out-of-state clinicians to perform telehealth visits with residents of their state and telehealth visits rose markedly by the end of 2020. Most of the interstate visits were between patients and clinicians who had established relationships, and the most common conditions treated were those that benefit from regular evaluation and management (E&M) visits, such as high blood pression, depression and anxiety, the news release said.

In some states, less than 1% of telehealth visits in 2020 were interstate. But there was great variation between states, with some locations such as Vermont, New Hampshire and Washington, D.C., seeing interstate visits making up 4% to 9% of all E&M visits conducted via telehealth. States whose residents were more likely to go out of state for in-person care also had higher interstate telehealth care.

Rural residents especially appeared to have taken advantage of interstate healthcare. Of all rural residents included in the study, 18% crossed state borders for in-person care or telehealth, compared to 13% of nonrural residents using interstate healthcare.

In 64% of interstate telehealth visits, the patient and provider were in neighboring states, such as patients in rural areas of Michigan who saw clinicians in Wisconsin or Indiana, according to the news release.

“For residents of the District of Columbia and states such as Vermont, West Virginia, Wyoming and New Hampshire, 15% or more of in-person and telehealth outpatient visits occur with a clinician in another state,” said Ellimoottil. “For these areas, finding a permanent solution to the interstate licensure issue is essential. For states like California and Texas, interstate healthcare may be a lower priority because less than 2% of total outpatient care occurs across state lines.”

This article originally appeared on the website


1. Andino JJ, Zhu Z, Surapaneni M, Dunn RL, Ellimoottil C. Interstate Telehealth Use By Medicare Beneficiaries Before And After COVID-19 Licensure Waivers, 2017-20. Health Aff (Millwood). 2022;41(6):838-845. doi: 10.1377/hlthaff.2021.01825

2. Doctors across state borders: Telehealth study could inform policy. Published online June 6, 2022. Accessed June 13, 2022.