Opportunities and Obstacles for Expanding Telehealth Access to Underserved PopulationsBy: Caregility Team
As a country, we’ve long known that rural communities struggle to access quality health care. Rural hospitals are closing in large numbers, according to the Center for Health Care Strategies, with more than 120 closing in the decade preceding the COVID-19 pandemic. Health care centers that have remained open struggle to attract and retain doctors, nurses, and other medical professionals; National Conference of State Legislatures data show only 11 percent of the country’s physician workforce is located in rural communities. These dwindling resources serve populations with deep-rooted health problems exacerbated by high rates of poverty and chronic conditions.
The promise of telehealth for underserved rural communities
The rapid expansion of telemedicine during the pandemic proved a silver lining for those seeking to expand health care access to these communities.
“Before the pandemic hit, rural hospitals were struggling financially and closing at a greater rate than ever before,” Neeraj Puro, an assistant professor health administration at Florida Atlantic University, told HealthTech magazine in January 2021. “The adoption of telehealth technology has given a new lease on life to the rural hospital itself.”
Here are a handful of examples of how hospitals and medical centers have implemented telehealth solutions to serve far-flung patients.
- A pilot program in South Dakota focused on using telehealth to improve outcomes for pregnant women with gestational diabetes in rural areas of North Dakota, South Dakota, Minnesota, Iowa, and Nebraska. The study’s results, explored in Medical Economics, showed that remote blood sugar screenings and interactive video visits decreased C-section rates by 20 percent and increased vaginal deliveries without complications by 27 percent among participants.
- On its “Telehealth and Rural Communities” web page, the CDC highlights many examples of how telehealth has been used to help people successfully manage chronic conditions. A home-based cardiac rehabilitation program, supplemented with smart devices and applications that connected patients with medical staff (for remote patient monitoring), produced safety and effectiveness measurements on par with in-person programs. Similarly, participants in a telehealth-based diabetes self-management program achieved weight loss and participation rates on the same level as those enrolled in physical programs.
- A northern Michigan hospital system pivoted away from traditional home and internet-based telehealth services when it realized that nearly half of the residents in its region lacked high-speed broadband internet access. The system – highlighted in an article published by the Journal of the American Medical Informatics Association – offered telehealth access via telephone or encouraged patients to complete a visit at a designated location that had reliable internet access.
What are the challenges related to telehealth services in rural communities?
Although there are numerous success stories like these, substantial challenges remain for telehealth access in rural and underserved communities as the pandemic comes to an end. “While telehealth has helped bridge the communication gaps, allowed for the continuation of care…some longstanding barriers must be addressed to improve the effectiveness of telehealth,” wrote the American Association of Family Physicians in July 2020.
Broadband internet access
The first significant challenge to telehealth in the post-pandemic world is broadband internet access. Reliable internet access is a prerequisite for telehealth services, but the Center for Health Care Strategies estimated in June 2020 that only 75 percent of households in non-urban areas have such access – compared with nearly 90 percent in urban areas. America’s political leadership seems to recognize this problem and are taking steps to solve it. The Biden Administration committed more than $6 billion in funds from the American Rescue Plan into community health centers, which focus on medically underserved communities and vulnerable populations – including rural communities. Additionally, the administration has requested an additional $65 million over 2021’s enacted level for the Rural e-Connectivity Program, created to help increase broadband internet capacity in rural communities.
Reimbursement, credentialing, and other policy concerns
The second major challenge to telehealth in the post-pandemic environment is the uncertainty surrounding future policy. Before the pandemic, Mirna Becevic, an assistant professor of telemedicine at the University of Missouri, told US News and World Report in 2018 that the technical expansion of telehealth isn’t the biggest headache for hospitals and health care centers – it’s the question of whether they’ll be reimbursed for telemedicine just as they would in-person care. If they won’t get paid for telehealth services, hospitals and medical centers will not be incentivized to provide them.
In response to the public health emergency wrought by the pandemic, the Centers for Medicare and Medicaid Services greatly expanded the number of telehealth services it deemed reimbursable. Many states dropped “originating site” restrictions that refer to the location of the patient at the time they receive medical care. Some states relaxed licensing and credentialing requirements, allowing doctors to provide medical care across state lines through telemedicine.
At this time, no one knows for certain whether these amended policies will continue beyond 2021 – but there’s reason to hope that, at least on the federal level, some changes will live on. For example, Secretary for Health and Human Services Xavier Becerra addressed expansion of telehealth as a priority for his department during his Senate confirmation hearings earlier this year. He specifically mentioned the importance of permanently enshrining payment parity for telemedicine as a “key component” of his strategy to “decrease health inequities, particularly in remote areas where it’s difficult to get in-person access to care.”
Regardless of what happens in the halls of government, telehealth – in some way, shape, or form – will remain a vital part of any strategy to provide better medical care to underserved rural communities. Caregility looks forward to being your partner in that process, enabling your hospital or health center to better serve your patients, no matter where they live.
Contact us to learn more about our telehealth solutions and consulting services.