Journal article
Permissive Telehealth State Licensure Policies Are Associated with Increased Telehealth Utilization
Telemedicine journal and e-health, Vol.31(9), 0089
09/02/2025
DOI: 10.1089/tmj.2025.0089
PMID: 40354295
Abstract
State professional licensure has been cited as a significant barrier to widespread telehealth adoption, and states have developed strategies to reduce such licensure burdens through policy changes. We aimed to measure the association between state-level medical licensure policies and outpatient telehealth utilization between 2018 and 2022 among Medicare beneficiaries.
We conducted a quasi-experimental study of a 5% sample of age-qualifying Medicare fee-for-service beneficiaries between January 2018 and December 2022. We assessed state-level medical licensure policy for telehealth visits, captured as participation in Interstate Medical Licensure Compact (IMLC) before the COVID-19 public health emergency (PHE) and/or policy relaxation during the COVID-19 PHE. Outcomes included out-of-state telehealth (OOS-TH) and in-state telehealth (IS-TH). We evaluated the association between state-level policies and outcomes through logistic regression, adjusting for patient-level characteristics and month/year of the encounter.
We analyzed 141,199,029 outpatient encounters for 1,682,501 Medicare beneficiaries. In the pre-COVID-19 era, IMLC participation was associated with higher OOS-TH (adjusted odds ratio [aOR]: 2.24; 95% confidence interval [CI]: 2.09-2.40) but not IS-TH (aOR: 0.98; 95% CI: 0.96-1.01). In the COVID-19 era, we observed higher IS-TH in IMLC-only states (aOR: 1.09; 95% CI: 1.08-1.10) and states with COVID-19 policy relaxations (aOR: 1.11; 95% CI: 1.10-1.12). We observed lower OOS-TH utilization by IMLC participation (aOR: 0.74; 95% CI: 0.72-0.75) and COVID-19 policy relaxations (aOR: 0.83; 95% CI: 0.81-0.85).
Permissive licensure policies were higher telehealth utilization, though we observed mixed effects in telehealth type (IS-TH vs. OOS-TH) and by time (pre-COVID-19 vs. COVID-19). Variability in IS-TH and OOS-TH utilization may indicate that while local policies can improve telehealth access, interstate barriers still exist.
Details
- Title: Subtitle
- Permissive Telehealth State Licensure Policies Are Associated with Increased Telehealth Utilization
- Creators
- Priyanka Vakkalanka - University of IowaTracy Young - University of IowaKnute D Carter - University of IowaFred Ullrich - University of IowaMarcia M Ward - University of IowaNicholas M Mohr - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Telemedicine journal and e-health, Vol.31(9), 0089
- DOI
- 10.1089/tmj.2025.0089
- PMID
- 40354295
- NLM abbreviation
- Telemed J E Health
- ISSN
- 1530-5627
- eISSN
- 1556-3669
- Publisher
- Mary Ann Liebert; NEW ROCHELLE
- Grant note
- Office for the Advancement of Telehealth
This study was supported by funding from the Office for the Advancement of Telehealth.
- Language
- English
- Electronic publication date
- 05/12/2025
- Date published
- 09/02/2025
- Academic Unit
- Rural Telehealth Research Center; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984823076002771
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