{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:09:54Z","timestamp":1778742594472,"version":"3.51.4"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["U3GRH40003\u201001\u201003"],"award-info":[{"award-number":["U3GRH40003\u201001\u201003"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider\u2010based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID\u201019 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationally representative 5% sample of Medicare Fee\u2010for\u2010Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019\u20132021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural\u2010Urban Continuum Codes were used to identify rural\u2013urban clinic locations. Logistic regression included three\u2010way interaction terms for time, rurality, and clinic type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre\u2010pandemic levels. FQHCs had higher telehealth use (18%\u201331%) than RHCs (8%\u201314%) in 2020\u20132021. Across all years, tele\u2010behavioral health was the primary venue for originating and distant site providers.\u00a0Overall, 19%\u201334% of originating site providers were psychiatrists and 10%\u201331% were primary care providers. Likely due to patients sheltering\u2010in\u2010place (at home), 2020\u20132021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%\u201315.8% in rural) followed by rural ID_RHCs (10.2%\u201311.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020\u20132021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.12920","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T08:20:51Z","timestamp":1738138851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Medicare telehealth utilization by Rural Health Clinics and Federally Qualified Health Centers prior to and during the COVID\u201019 pandemic"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-3445","authenticated-orcid":false,"given":"Yvonne","family":"Jonk","sequence":"first","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-8818","authenticated-orcid":false,"given":"John","family":"Gale","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Thayer","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.34882"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6936a4"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000029439"},{"key":"e_1_2_9_5_1","unstructured":"MehrotraA ChernewME LinetskyD HatchH CutlerDM SchneiderEC.The Impact of COVID\u201019 on outpatient visits in 2020: Visits Remained Stable Despite a Late Surge in Cases. The Commonwealth Fund. Accessed January 19 2024. doi:10.26099\/bvhf-e411"},{"key":"e_1_2_9_6_1","unstructured":"Coronavirus Aid Relief andEconomic Security Act (CARES Act): Sec. 3704.Enhancing Medicare telehealth services for federally qualified health centers and rural health clinics during emergency period H.R.748. 116th Congress Second Session (2020). January 3. Accessed June 17 2024.https:\/\/www.congress.gov\/116\/bills\/hr748\/BILLS\u2010116hr748enr.pdf"},{"key":"e_1_2_9_7_1","unstructured":"Centers for Medicare&Medicaid Services Medicare Learning Network.MLN Fact Sheet: Telehealth Services. 2024. MLN901705. April. Accessed January 19 2024.https:\/\/www.cms.gov\/files\/document\/mln901705\u2010telehealth\u2010services.pdf"},{"key":"e_1_2_9_8_1","unstructured":"Centers for Medicare&Medicaid Services.Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID\u201019. 2023. Accessed January 19 2024.https:\/\/www.cms.gov\/files\/document\/rural\u2010health\u2010clinics\u2010and\u2010federally\u2010qualified\u2010health\u2010centers\u2010cms\u2010flexibilities\u2010fight\u2010covid\u201019.pdf"},{"key":"e_1_2_9_9_1","unstructured":"Centers for Medicare&Medicaid Services Medicare Learning Network.New & Expanded Flexibilities for Rural Health Clinics & Federally Qualified Health Centers. 2023. SE20016. Accessed January 19 2024.https:\/\/www.cms.gov\/files\/document\/se20016\u2010new\u2010expanded\u2010flexibilities\u2010rhcs\u2010fqhcs\u2010during\u2010covid\u201019\u2010phe.pdf"},{"key":"e_1_2_9_10_1","unstructured":"Consolidated Appropriations Act 2021. H.R. 133 Pub L No. 116\u2013260 116th Congress (2019\u20102020) (2021). December 27 2020. Accessed May 27 2021.https:\/\/www.congress.gov\/bill\/116th\u2010congress\/house\u2010bill\/133"},{"key":"e_1_2_9_11_1","unstructured":"StaufferR KniznerL CurtisD.Consolidated Appropriations Act Extends Select Telehealth Flexibilities;2023. Accessed June 17 2024.https:\/\/www.mcdermottplus.com\/insights\/2023\u2010consolidated\u2010appropriations\u2010act\u2010extends\u2010select\u2010telehealth\u2010flexibilities\/"},{"key":"e_1_2_9_12_1","unstructured":"Centers for Medicare&Medicaid Services.Provider of Services File \u2010 Hospital & Non\u2010Hospital Facilities. Accessed January 19 2024.https:\/\/data.cms.gov\/provider\u2010characteristics\/hospitals\u2010and\u2010other\u2010facilities\/provider\u2010of\u2010services\u2010file\u2010hospital\u2010non\u2010hospital\u2010facilities"},{"key":"e_1_2_9_13_1","unstructured":"Centers for Medicare&Medicaid Services.Medicare Telemedicine Health Care Provider Fact Sheet;2020. Accessed January 19 2024.https:\/\/www.cms.gov\/newsroom\/fact\u2010sheets\/medicare\u2010telemedicine\u2010health\u2010care\u2010provider\u2010fact\u2010sheet"},{"key":"e_1_2_9_14_1","unstructured":"Centers for Medicare&Medicaid Services.List of Telehealth Services. Accessed January 19 2024.https:\/\/www.cms.gov\/medicare\/coverage\/telehealth\/list\u2010services"},{"key":"e_1_2_9_15_1","unstructured":"U.S. Department of Health and Human Services Health Resources and Services Administration.Billing Medicare as a Safety\u2010Net Provider. Accessed January 23 2025.https:\/\/telehealth.hhs.gov\/providers\/billing\u2010and\u2010reimbursement\/billing\u2010medicare\u2010as\u2010a\u2010safety\u2010net\u2010provider"},{"key":"e_1_2_9_16_1","unstructured":"Centers for Medicare & Medicaid Services.Restructured BETOS Classification System. Accessed January 19 2024.https:\/\/data.cms.gov\/provider\u2010summary\u2010by\u2010type\u2010of\u2010service\/provider\u2010service\u2010classifications\/restructured\u2010betos\u2010classification\u2010system"},{"key":"e_1_2_9_17_1","unstructured":"Agency for Healthcare Research and Quality.Healthcare Cost & Utilization Project: User Support. Accessed June 17 2024.https:\/\/hcup\u2010us.ahrq.gov\/home.jsp"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3354"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269535"},{"key":"e_1_2_9_20_1","unstructured":"ICD10Data.com. 2024 ICD\u201010 \u2010CM Codes. Accessed June 17 2024.https:\/\/www.icd10data.com\/ICD10CM\/Codes"},{"key":"e_1_2_9_21_1","unstructured":"The Johns Hopkins ACG\u00ae System Population Health Analytics software. Version 12.0;2019. Accessed January 19 2024.https:\/\/www.hopkinsacg.org\/article\/now\u2010available\u2010v12\u20100\u2010the\u2010johns\u2010hopkins\u2010acg\u2010system\/"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14337"},{"key":"e_1_2_9_23_1","volume-title":"Medicare Advantage Enrollment, Plan Availability and Premiums in Rural Areas","author":"Fuglesten Biniek","year":"2023"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19183"},{"key":"e_1_2_9_25_1","unstructured":"SamsonLW TaraziW TurriniG SheingoldS.Medicare Beneficiaries\u2019 Use of Telehealth in2020: Trends by Beneficiary Characteristics and Location.2020;2024. Issue Brief HP\u20102021\u201027. U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. Accessed January 19 2024.https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/a1d5d810fe3433e18b192be42dbf2351\/medicare\u2010telehealth\u2010report.pdf"},{"key":"e_1_2_9_26_1","unstructured":"Centers for Medicare&Medicaid Services.Medicare Telehealth Trends. November 2024. Accessed January 23 2025.https:\/\/data.cms.gov\/summary-statistics-on-use-and-payments\/medicare-medicaid-service-type-reports\/medicare-telehealth-trends"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2015.192"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/01612840.2018.1499157"},{"key":"e_1_2_9_29_1","unstructured":"OsterNV PattersonDG SkillmanSM FrognerBK.COVID\u201019 and the Rural Health Workforce: the Impact of Federal Pandemic Funding to Address Workforce Needs. Center for Health Workforce Studies. University of Washington. Policy Brief; March2022. Accessed January 19 2024.https:\/\/www.healthworkforceta.org\/wp\u2010content\/uploads\/2022\/04\/Covid\u201019\u2010and\u2010the\u2010Rural\u2010Health\u2010Workforce\u2010PB\u2010202271.pdf"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/13561820.2021.1967896"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.7326\/m19\u20100283"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12759"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.12920","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.12920","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.12920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T06:32:56Z","timestamp":1778740376000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.12920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/jrh.12920"],"URL":"https:\/\/doi.org\/10.1111\/jrh.12920","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-08-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12920"}}