Impact of state policies on telehealth use among the privately insured with newly diagnosed cancer.

Abstract

1607 Background: The COVID-19 public health emergency (PHE), declared on January 31, 2020, relaxed many telemedicine restrictions. Yet there remains wide variation across states on the coverage and reimbursement of telemedicine services and rules to permit practicing across state lines. Research has shown expanded access to telemedicine is beneficial to cancer patients, making it important to understand the relationship between state policies and the use of telemedicine. Methods: We identified privately insured non-elderly patients newly diagnosed with any of five common cancers (female breast, prostate, lung, colorectal, and lymphoma) between March 2019 and March 2021 from Optum Clinformatics Data Mart. We characterized state telehealth policies by parity status (coverage & payment parity, coverage parity only, and none) and rules for cross-state practice (allowed with vs. without limitations). We applied interrupted time series analysis to examine the trend of telemedicine use before and after the declaration of COVID-19 PHE and conducted multivariable logistic regression to examine the association between state policies and telemedicine use while controlling for other confounders. Results: Of the 10,813 privately insured non-elderly patients, the adjusted rate of telemedicine use was 23.6%. The average age was 53.2 (SD = 9.24). Race/ethnicity distribution was 71.20% non-Hispanic White, 10.07% non-Hispanic Black, 8.56% Hispanics, 3.77% Asians, and 6.39% others. Lymphoma, female breast, colorectal, lung, and prostate cancer accounted for 10.55%, 46.55%, 13.27%, 7.56%, and 22.07% of patients. A sharp increase was observed early on (from 32.4% in March 2020 to 42.5% in April 2020), followed by a steady decline, down to < 15% by March 2021. Compared to patients residing in states with coverage and payment parity, those in states with only coverage parity and no parity were significantly less likely to use telemedicine (OR = 0.79, 95% CI: [0.71 – 0.88]; OR = 0.77, [0.68 – 0.87]). Patients residing in states with more restrictions/regulations on cross-state practice were significantly less likely to use telemedicine (OR = 0.84, [0.76 – 0.93]) than those in states that were less restrictive. Other factors predicting lower likelihood of telemedicine use included older age (OR = 0.69 [0.62-0.77] for age 50-64 vs. 20-49), non-Hispanic Black (OR = 0.84 [0.72 – 0.98] vs. non-Hispanic White), colorectal cancer (OR = 0.82 [0.70 – 0.96] vs. female breast), and more recent diagnosis. Conclusions: With the approaching end of COVID-19 PHE, states are deciding whether to permanently relax certain telemedicine policies or return to existing more restrictive policies. Our study suggests patients residing in states that move toward less generous parity and more restrictive cross-state practice rules may be less likely to benefit from telemedicine.