Using Technology to Improve Healthcare Access in Rural Communities

September 1, 2020

The day-to-day experience of healthcare providers in rural communities looks a lot different than that of their peers working in more heavily populated cities. “If you’re in a small, rural town, you don’t see a lot of emergencies,” said Texas Rural Health Association board member Mike Easley.

This means that certain procedures learned during their education and professional training may not be performed on a regular basis, making it important to have support when an emergency does arise.

Through tele-emergency medicine, rural providers can consult with a physician at a different location to receive guidance when performing a critical procedure, such as intubating a patient.

“[The telemedicine provider is] able to observe the tube as it’s being inserted into the patient, and they can advise you [throughout the procedure],” Easley explained.

Since 2010, approximately 120 rural hospitals have closed — 20 of which were located in the state of Texas alone, according to a report on state-by-state hospital closures.

This use of technology is one example of how telehealth can benefit rural communities, a fact that has been emphasized by the current COVID-19 pandemic.

With limited access to care, paired with the challenges of social distancing created by the pandemic, providers and patients alike have increased their use of telehealth, demonstrating the potential long-term benefits of such technologies once the pandemic is contained.

However, barriers to the use of telehealth in these communities still exist. It is important for health professionals and rural community leaders to advocate for better access to care through innovations like telehealth.

The Use of Telehealth in Rural Communities for COVID-19

In the wake of COVID-19, telehealth services have been increasingly leveraged to provide a variety of healthcare services to minimize physical contact for non-emergencies, such as primary care visits, and expand the reach of experts to underserved communities.

Increased access to telehealth amid the pandemic is due in part to emergency legislation that eased some restrictions for providers, such as the ability to practice across state lines, as reported in USA Today. This has been beneficial in underserved rural communities, where there are fewer local health facilities and less access to local specialists.

Since 2010, approximately 120 rural hospitals have closed — 20 of which were located in the state of Texas alone, according to a report on state-by-state hospital closures. This trend has left rural residents with fewer accessible facilities and longer commutes to receive care.

Barriers to Telehealth Access in Rural Communities

Despite the uptick in the use of telehealth technologies in response to COVID-19, some barriers remain for rural communities, particularly in the long-term.

Technology
Easley explained that not all rural areas have access to sufficient broadband internet to facilitate virtual sessions between patients and providers. Additionally, some residents in these areas may not own a smartphone or have a computer at home.

Coverage and Payment
Rural Health Clinics (RHCs) serve patients on Medicare, which does not cover the cost of telehealth services in the same way as in-person visits. While the Coronavirus Aid, Relief, and Economic Security (CARES) Act (PDF, 228 KB) has changed this policy for the short-term, previous coverage policies were “a little bit of a disincentive to provide telemedicine,” Easley said.

State Laws for Providers
“Each state has its own licensing for physicians,” Easley said. “So, you have to be licensed in the state where you’re actually seeing a patient.” This, in turn, limits the number of available providers for telehealth services. Emergency legislation has eased these restrictions but serves as a temporary solution.

Is Telehealth a Long-Term Solution?

While many challenges exist for rural communities with regards to access, many healthcare advocates are hopeful that the use of telehealth technologies will continue to increase after the pandemic.

“There will be a wave of ongoing adoption and increased acceptance [of telehealth], even as the pandemic begins to wind down,” Dr. Wyatt Decker said in USA Today.

Building on emergency measures that were introduced in response to COVID-19 could also lead to longer-term solutions for expanding access to telehealth technologies.

For example, Representatives Adrian Smith, R-Neb., and Tom O’Halleran, D-Ariz., introduced the Improving Telehealth for Underserved Communities Act in May 2020 to incentivize telehealth in rural communities. Post-pandemic, additional efforts could be made to maintain this measure.

How Leaders Are Advocating for Telehealth in Rural Communities

According to a fact sheet from the National Association of Rural Health Clinics, the Improving Telehealth for Underserved Communities Act aims to address how RHCs and Federally Qualified Health Centers (FQHCs) are reimbursed for telehealth services.

Rural Health Clinics are facilities located in rural, underserved areas that receive certification in order to receive reimbursement for serving Medicare and Medicaid patients.
Federally Qualified Health Centers are facilities that provide care to underserved populations, such as immigrants or individuals experiencing homelessness, and receive funds from the Health Resources & Services Administration (HRSA) Health Center Program.

Current policy requires RHCs and FQHCs to treat telehealth visits differently than in-person visits for cost reporting. This disincentivizes use of telehealth in a number of ways. For example, telehealth visits do not count toward productivity standards, which are a requirement for RHCs to receive reimbursement.

The Improving Telehealth for Underserved Communities Act proposes that:

RHCs and FQHCs bill telehealth visits through their normal reimbursement mechanisms.
Costs associated with telehealth would count on annual cost reports.
Telehealth visits count toward productivity standards.

Resources for Further Reading

Telehealth in Rural Communities | Centers for Disease Control and Prevention (CDC)
This resource from the CDC details how telehealth programs can be developed for rural communities to improve healthcare access.

Telehealth Use in Rural Healthcare | Rural Health Information (RHI) Hub
RHI Hub, a website supported by HRSA, offers information and resources on health topics for rural communities. This guide focuses on telehealth and includes a toolkit, FAQ section, and more.

Telehealth Programs | Health Resources & Services Administration (HRSA)
HRSA provides a detailed list of current grant programs for telehealth offered through the Office for the Advancement of Telehealth (OAT), as well as external resources for funding.

Why Is Telehealth Important for Rural Providers? | HealthIT.gov
This article highlights the benefits of telehealth for rural communities and explains how telehealth technologies can be utilized for this specific patient population.

Telehealth | National Rural Health Resource Center (NRHRC)
This archive on the NRHRC website includes a variety of articles and resources related to the topic of telehealth in rural healthcare.

Bridging the Digital Divide for All Americans | Federal Communications Commission
Internet access plays a critical role in making telehealth viable in rural communities. This resource from the FCC highlights its current efforts to improve internet access in rural areas.

Citation for this content: The MPH online program from Baylor University’s Robbins College of Health and Human Sciences