Perceptions of Telemedicine Use for Specialist Care in Skilled Nursing Facilities.

Importance: For long-term residents of skilled nursing facilities (SNFs), greater use of telemedicine for specialist care may improve access to and overall quality of care. Although policy changes during the COVID-19 pandemic facilitated greater use of telemedicine, such use now is rare, and it is unclear why. Objective: To examine SNF clinical leaders' perceptions of telemedicine use and explanations of lower use among long-term residents. Design, Setting, and Participants: This survey study was conducted online and via postal mail from February 7 to July 28, 2025, among directors of nursing of SNFs, the central decision-makers for daily clinical operations. A probability-based sample was drawn from a listing of all 14 084 SNFs in the US, stratified to ensure reach to facilities of different sizes and varying telemedicine utilization. Main Outcomes and Measures: This study measured the perceptions of key factors associated with quality of care in SNFs. Telemedicine use for specialist care and reasons for telemedicine use and disuse were solicited from SNFs' directors of nursing. The demographic characteristics of SNFs surveyed were weighted to Centers for Medicare & Medicaid Services benchmarks to reflect the profile of SNFs nationally. Results: Among 1001 directors of nursing sent invitation letters, 379 (39%) participated in this study. Most directors of nursing whose residents used telemedicine confirmed its proposed advantages: respondents said a top reason for using telemedicine is that it helped less-mobile patients get appointments (77%; 95% CI, 71%-82%) and that it helped improve patients' quality of care (73%; 95% CI, 67%-78%). Top reasons for not using telemedicine among less-frequent users and nonusers were: telemedicine visits were not frequently offered by specialists (73%; 95% CI, 67%-79%) and telemedicine did not offer higher quality of care over normal practices (62%; 95% CI, 56%-68%). A majority of directors of nursing who use telemedicine (60%; 95% CI, 54%-65%) also reported that telemedicine placed additional time burdens on nursing staff. Conclusions and Relevance: This survey study found that frontline clinical leaders view specialist telemedicine care as a useful tool for SNFs, particularly for patients with low mobility. However, they reported that telemedicine is offered too infrequently by specialists and adds to nurses' schedules. Policy and payment reforms should include incentives for specialists to offer telemedicine and reimbursement for nursing staff time.