Telemedicine for Specialty Care

Telemedicine has been touted as a means to increase access to specialty care and improve the quality of care that patients receive, particularly in areas that do not have access to specialists like rural areas. In an effort to encourage greater use of telemedicine, more than half of states in the U.S. have passed telemedicine parity laws, which mandate that telemedicine visits by private insurers and/or Medicaid plans are covered. In contrast to these states and many private health plans, Medicare has taken a more cautious approach in reimbursing for telemedicine. Current Medicare regulations mandate that the interaction occur via live videoconference and that the patient must be hosted at a clinic or facility such as a hospital or skilled nursing facility in a rural region.

Our research group has assessed several aspects of telemedicine for specialty care. We have identified the use of telemedicine among Medicare beneficiaries, as well as the variation in use of telemental health. We have also assessed whether the introduction of a teledermatology service increased the utilization of dermatology care among enrollees in a Medicaid plan in California. 
 
At a higher level, we've explored how can telemedicine decrease or increase costs and payment policy. Here is a link to my congressional testimony on payment for telemedicine. 
 
  • Wilcock AD, Rose S, Busch AB, Huskamp HA, Uscher-Pines L, Landon B, Mehrotra A. Is broadband internet a barrier to telemedicine use? JAMA Internal Medicine. In Press
  • Kanagasingam Y, Xiao D, Vignarajan J, Preetham A, Tay-Kearney ML, Mehrotra A. Evaluation of Artificial Intelligence-Based Grading of Diabetic Retinopathy in Primary Care. JAMA Network Open. 2018 Sep 7;1(5):e182665
  • Licurse AM, Mehrotra A. The Effect of Telehealth on Spending: Thinking Through the Numbers. Ann Intern Med. 2018 May 15;168(10):737-738. doi: 10.7326/M17-3070. Epub 2018 Apr 1 PubMed PMID: 29632952.
  • Uscher-Pines, Lori, Rosalie Malsberger, Lane Burgette, Andrew Mulcahy, and Ateev Mehrotra. “Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees.” JAMA Dermatology 152, no. 8 (August 1, 2016): 905–12. doi:10.1001/jamadermatol.2016.0938
  • Mehrotra A, Jena A, Busch A, MD, Souza J, Uscher-Pines L, Landon B. Utilization of Telemedicine among Rural Medicare Beneficiaries. JAMA. 2016 May 10;315(18):2015-6. doi: 10.1001/jama.2016.2186.
  • Mehrotra A, MD, Souza J, Uscher-Pines L, Landon B., Jena A, Busch A,  Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States. Health Affairs. 2017
  • Ray KN, Ashcraft LE, Mehrotra A, Miller E, Kahn JK. Family perspectives on telemedicine for pediatric subspecialty care. Telemedicine and e-Health. In press.
  • Uscher-Pines L, Rudin R, Mehrotra A. Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities. Telemedicine Journal and eHealth. 2016 Nov 28.
  • Rudin R, Auerbach D, Zaydman M, Mehrotra A. Paying for Telemedicine, AJMC. 2014 Dec; ;20(12):983-5.