State-Specific Variation in Medicare Telehealth Utilization During the COVID-19 Pandemic

A number of reports are available exploring how telehealth use grew during the COVID-19 pandemic and public health emergency. Some have reported variations in telehealth uptake by specialty, but few have explored growth in telehealth utilization by both specialty and state, arguably the most salient combination of regulatory domains. We extracted telehealth claims from Medicare public use data files in 2019 and 2020. We calculated utilization by state both as raw encounters and as encounters per 10,000 Medicare beneficiaries in each state. We categorized providers into four major groups (primary care, specialty care, nurse practitioners and physician assistants, and behavioral health) to further explore variations in uptake among these groups. We generated tables and maps to display the variations found. Growth in raw telehealth encounter volume was dominated by large states. Growth in telehealth volume per 10,000 beneficiaries was dominated by states in the Northeast and showed four- to fivefold variation between the least and greatest. Growth by state and provider group varied by even wider margins, with some states showing large amounts of growth among some provider groups, but relatively little growth in others. No states showed relatively robust growth in telehealth across all provider groups. Growth in telehealth during the public health emergency was generally robust, but varied considerably across states and provider types. Recognizing this variation is important, and further exploring potential sources of variation is an important task for future research.