The Executive Suite: Expanding telehealth in rural areas

While those who live in major metropolitan areas across the U.S. have quick, reliable access to hospitals and health care providers, people residing in rural communities often lack the ability to find easily accessible clinicians and health care facilities and services. According to a post on Americanprogress.org, even though only 14% of Americans live in rural areas, these communities represent 67% of the nation’s primary care health professional shortages. In these rural communities, residents are disadvantaged not only by place and class, but low-income rural people of color are also disadvantaged by race.

The COVID-19 pandemic starkly illustrated the urban-rural divide in American health care, as many hospitals serving rural areas have closed recently. Some of the reasons include low patient volume, workforce shortages, budget cuts, and a move toward outpatient care. Not coincidentally, rural areas have also seen deaths from conditions like heart and lung diseases increase significantly.

Yet according to a post on USNews.com, these health care issues present opportunities for innovation. Alan Morgan, chief executive officer of the National Rural Health Association, said as much in a recent seminar: "Looking at rural communities, you really get a sense of where the country's going to be 10 to 20 years from now.” He pointed to past innovations such as the expansion of telemedicine, especially during the pandemic, as examples of that.

Virtual care has great potential to improve not only rural communities’ health, but also health equity. Clinicians can pre-screen patients virtually before sending them to a crowded facility, and can expedite telehealth appointments between city-based health care providers and patients in rural areas.

In an interview posted on HealthcareITnews.com, Shayan Vyas, senior vice president and medical director of hospital and health systems at Teledoc Health, said he was optimistic about virtual care’s potential to address and improve rural health care access. In particular, he expressed enthusiasm for the “hub and spoke” model of telehealth, which he described as a system “where hospitals and health systems can partner to bring specialist care closer to those who live in rural and underserved communities.”

He expanded on that as follows:“Rather than requiring patients to travel to a health system's hub where most specialists are—or have clinicians travel to rural clinics to see patients—we work with them to enable their clinics within rural communities with virtual care capabilities, so patients may remain within their local community while still accessing specialists they would have had to travel often hours to see.”

The Robert Wood Johnson Foundation, in partnership with the University of San Francisco, produced a report to assist those working to improve health, well-being, and equity in rural America. The report listed the following recommendations to advance rural health equity:

Make long-term economic and community development the focus of any strategy to support rural health equity by targeting rural areas with extreme poverty.
Focus on addressing systemic racism in rural areas through strategies that provide economic opportunities for rural people of color.
Invest in educational opportunities for all rural residents, particularly people of color and those living in poverty.
Ensure all rural residents have reliable internet access to support education, employment, telemedicine, and community participation.
Increase opportunities for Indigenous, Black, and Latino/Hispanic residents by encouraging them to vote and offering universal mail-in ballots in every state.
Invest in various means of transportation such as rural car sharing
Build and maintain rural clinics.

It’s clear that having the right tools and technology can help ensure sustainable quality in medical transports—often necessary in rural areas—and this can dramatically benefit hospitals and other facilities in terms of patient outcomes and overall costs. Dr. Richard Watson, co-founder of the health IT vendor Motient, emphasized in a recent interview with Healthcare IT News the growing importance not only of telehealth, but “the tools to enable data analysis around the personality of rural facilities.”

He went on to say that such technology will reveal the health patterns in such communities and allow residents to remain closer to home for their care, while at the same time enabling providers to “find the answer to quality and sustainability questions.” Further, he believes that payers need to reexamine reimbursement models in rural areas and understand that quality metrics and edicts do not apply.

“All of the geographic and demographic offsets will do little to counterbalance that,” he said. “It seems the current reimbursement schema allows rural facilities to barely keep their heads above water.”

In addition to better use of technology, staff shortages in rural hospitals and clinics can be amended by identifying students in those communities and enticing them to consider training that includes working in a rural setting rather than in a big city. And policies that help to offset the costs of medical and dental education can also help to expand the health care workforce. With the expansion of telemedicine during the pandemic and beyond, both the federal government and individual states are working to expand this technology and other tools to help ensure rural communities have access to the vital care they require.