Have you ever visited McMullen, Alabama or traveled to Hobart Bay, Alaska? How about Jerome, Arizona or Magnet Cove, Arkansas? If you’ve never stepped foot in any of these American towns, you’re probably not alone. Along with Vernon, California, they’re five of the smallest towns in the United States.
Rural areas make up 97 percent of the U.S. Rural America is home to approximately 60 million people, and almost 20 percent of the country’s total population lives in these areas.
Though residents of rural communities enjoy a plethora of advantages, from lower crime rates and less pollution to easier access to outdoor recreation and a more economical cost of living, many also face at least some lack of access to healthcare services. Even though rural residents are more likely than their urban counterparts to have chronic diseases, a majority of them have to travel at least an hour to reach a specialist or more technologically-advanced hospital.
Healthcare providers serving these rural regions encounter obstacles, too. There are 1,805 rural community hospitals and 350 critical access hospitals (CAHs) located throughout the U.S. They wrestle with persistent challenges such as low patient volume, geographic isolation, workforce shortages and aging infrastructure.
Access Advantages to Advance Rural Health
Telehealth and telemedicine are increasingly used by providers and patients in rural areas to improve access to care. It allows residents living in rural areas to receive a higher quality of care, reduces costs and promotes continuity of care through real-time communication, responsive concern and reduced admissions.
The American Hospital Association notes that the most frequent use cases for telehealth are pharmacy services, chronic care management, telestroke services, tele-ICU tools, specialty telemedicine consults, diagnostic screening for diabetes-related eye disease, sleep disorders, telepsychiatry and opioid-use disorder (OUD). Some healthcare providers employ telehealth technology to manage chronic conditions, monitor patients in real-time, manage medications, provide individual and group patient education, supervise rehabilitation and self-management techniques, serve as follow-up visits once the patient is discharged, and store and forward information.
According to the Rural Health Information Hub (RHIhub), effective healthcare services administered through telehealth technology in rural communities include:
- Chronic care management interventions
- Provider-to-provider models
- Access to emergency care providers in real-time for evaluations and consults to local providers
- Home monitoring
- Intensive care units (ICUs)
- Long-term care
- Online therapy and remote counseling
- Telepharmacy
- Virtual professional communities
- Interpreter services
- School-based telehealth
Telehealth use skyrocketed during the COVID-19 pandemic, especially for rural providers and patients. The rate of telehealth visits among rural patients significantly increased to 147 visits per 1,000 patients in June 2020, up from the previous rate of seven per 1,000 in December 2019..
In a telehealth impact study conducted by the COVID-19 Healthcare Coalition, more than 75 percent of physicians surveyed reported that telehealth enabled them to provide quality care in the areas of COVID-19-related care, acute care, chronic disease management, hospital follow-up, care coordination, preventative care and mental/behavioral health.
To assess the broadband capacity available to rural healthcare providers and improve patient access to telehealth services, the Department of Health and Human Services (HHS) announced an $8 million investment to launch the Telehealth Broadband Pilot (TBT). The three-year pilot program is set to improve connectivity in rural areas of Michigan, Alaska, West Virginia and Texas.
A Resource for Value-based Care
The use of telehealth also is an important component for providers, including those serving rural residents, transitioning from fee-for-service (FFS) to value-based care. Value-based care programs are defined by the Centers for Medicare & Medicaid Services as those that “reward health care providers with incentive payments for the quality of care they give to people with Medicare” and support the agency’s three-part aim of better care for individuals, better health for populations and lower cost.
Telehealth services are an effective way to reduce the cost of care, making them valuable tools to use in value-based reimbursement models that reward hospitals and health systems for lower utilization costs. Remote patient management through telehealth promotes value-based care by enabling multidisciplinary teams to create a more patient-centric experience. Also, by reducing wait times and lowering care costs, the use of telehealth can improve other value-based care metrics along with providers’ Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores.
Telehealth Legislation and Regulatory Changes
The increased use of telehealth during the COVID-19 pandemic was partially due to numerous legal and regulatory changes, including expansion of telemedicine services reimbursement, relaxation of regulatory technology requirements, implementation of novel approaches to licensure and credentialing and relaxation of supervision laws related to nonphysician providers. Five states that did not previously require coverage of telehealth services – Utah, Illinois, West Virginia, New Hampshire and Massachusetts – changed their policies during the pandemic, bringing the total number of states that currently require coverage to 40.
Several pieces of legislation to advance the use of telehealth post-pandemic have been introduced, although few have been signed into law. For example, a bipartisan group of U.S. representatives reintroduced the Protecting Access to Post-COVID-19 Telehealth Act of 2021 earlier this year. The bill, as stated, would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and require a study on the use of telehealth during COVID, including its costs, uptake rates, measurable health outcomes and racial and geographic disparities.
Another bill, the Increasing Rural Telehealth Act, would help expand remote patient monitoring programs in rural areas. It would require the Health and Human Services secretary to create a $50 million grant program to fund pilot remote patient monitoring programs in rural areas and develop a report two years later on the effectiveness of the program.
More recently, a bipartisan group of Senators cosponsored the Protecting Rural Telehealth Access Act, which is designed to ensure underserved community health providers can continue accessing virtual care beyond the end of the COVID-19 pandemic. The bill would permanently allow rural health clinics and Federally Qualified Health Centers (FQHCs) to serve as distance sites for providing telehealth services and allow Critical Access Hospitals to directly bill for telehealth services.
At Providertech, we collaborate with FQHCs and other provider groups serving complex populations to connect them to underserved patients who need their care and support. Using automated and scalable outreach and telehealth technology, we help them strengthen financial performance while improving outcomes for their at-risk populations. To learn more, schedule your free demo!