A high proportion of Medicare beneficiaries cross state borders to access cancer care, particularly patients residing in rural areas, according to a recent study published by Moen et al in JAMA Network Open. The findings have significant implications for telehealth policies and physician licensure, according to the study's authors.
Background
Telehealth is incapable of replacing cancer-care services provided in a clinical setting; nonetheless, it can help address gaps in cancer treatment and can also be used to manage treatment-related adverse effects, clinical trial check-ins, and prevention services.
“[Patients with cancer], especially [those] in rural areas, often travel far distances to receive specialized cancer care, [b]ut there are limitations on how physicians can follow up with their patients and practice across state lines, virtually, with telehealth,” stressed senior study author Tracy Onega, PhD, MA, MPAS, MS, Senior Director of Population Sciences at the Huntsman Cancer Institute at the University of Utah. “We can use the data from this study to inform policy and practices in order to remove this kind of barrier to health care,” she continued.
The use of telehealth in health care has increased since the COVID-19 pandemic. According to the National Center for Health Statistics, 37% of adult patients used telehealth in 2022, but stumbling blocks remain. The practice of medicine is governed by individual state medical boards and the cross-state licensure policies vary by state. Some states have more favorable telehealth policies, encouraging connected care regardless of the location, whereas other states have retained decades-old policies predating telehealth technologies. As a result, antiquated medical licensure governance often prohibit health-care providers from engaging with patients residing in rural areas through telehealth.
“Some states have reciprocity, meaning that a [physician] licensed in [one state] may also be automatically licensed in the next state over, [b]ut that is limited,” Dr. Onega emphasized. “It would be great to expand those options so that we don’t have so many of these barriers for physicians to be able to provide services across state lines by telehealth.”
Study Methods and Results
In the study, researchers surveyed over 1 million Medicare beneficiaries with cancer.
The researchers found that 7% of Medicare beneficiaries crossed state borders to receive cancer care. Among the beneficiaries, 8.3%, 6.7%, and 5.6% of all patients crossed state lines for surgical procedures, radiation therapy, and chemotherapy, respectively.
However, these figures were higher among rural patients—18.5% of whom traveled to other states for surgical procedures, 16.9% of whom traveled for radiation therapy, and 16.3% of whom traveled for chemotherapy.
“Patients are traveling across state lines for specialized cancer treatment services that need to be done in a brick-and-mortar clinic—but surgical assessment and follow ups could be offered by telehealth. A surgeon can follow patients remotely, and they can assess their progress from a distance,” suggested Dr. Onega. “This would reduce additional travel burdens for all patients and their caregivers, especially those in rural and frontier areas.”
Conclusions
The researchers hope their findings can help enhance access to cancer care among patients who live far from major medical centers. Altered health-care policies could lead to more positive outcomes for patients, their caregivers, provider teams, and insurers, they added.
“The patients are always first. We have so many improvements in cancer-care technologies now, many of which are benefiting patient outcomes. [Patients] are living longer and better lives after a cancer diagnosis,” underscored Dr. Onega. “We want to make sure that [patients] who live far away from an urban area can have all the same benefits,” she concluded.
Disclosure: The research in this study was supported by the National Institutes of Health/National Cancer Institute and the Huntsman Cancer Foundation. For full disclosures of the study authors, visit jamanetwork.com.
