Urgent Need and Significant Opportunities for Telemedicine in Rural Areas
Michael Morris | Senior Editor, iTelemedicine
August 11, 2015
An Urgent Need for Rural Telehealth
Most people agree that healthcare should be available to everyone, rich or poor, whether they live in the country or city, regardless of race, age, or gender. But today, people who live in rural regions of the United States are severely underserved, and rural healthcare itself is endangered. Heart attacks, strokes and traumatic injuries require immediate intervention. An hour or more drive to an urban hospital can be the difference between life and death. This is when the availability of rural telemedicine is imperative.
Why Rural Hospitals Are Disappearing
Throughout the country, rural hospitals are closing, or are in danger of closing and rural communities are in a health crisis. With fewer physicians wanting to work in rural areas, small hospital budgets unable to absorb the costs of mandatory electronic health records (EHRs) and many other pressures, rural hospitals are endangered and rural healthcare is in decline.
The National Rural Health Association, representing around 2,000 small hospitals throughout the U.S., reports that 48 rural hospitals have closed since 2010; the majority in southern states, and 283 others are endangered.
Rural hospitals also endure multiple conditions that push down profits, making it nearly impossible to arrive at economies of scale. These include:
- Reduced populations
- A higher percentage of uninsured and elderly patients
- The need to pay doctors higher rates to work in remote regions
- Expensive equipment that is often underused
- The absence of high-profit specialty services
- Disproportionate burden of emergency and urgent care, which are perennial money-losers.
A Shortage of Rural Healthcare Workers
Rural healthcare facilities face an increased challenge in maintaining an adequate number of qualified healthcare workers. A nationwide shortage of nurses has existed for some time, but the staff shortages in rural areas extend much further. Nurse practitioners, physician assistants, and family medical doctors are in critical demand and are in extremely short supply in rural areas.
Physicians in rural regions face greater pressures than their urban counterparts, including inadequate assistance, over-burdened rotation schedules, and lack of modern equipment. Although 20 percent of the U.S. population lives in rural areas, only nine percent of physicians practice in rural settings.
Opportunities and Challenges in Rural Telehealth Delivery
Although many factors still hinder the implementation of telemedicine in rural areas, the opportunities are outweighing the challenges and that’s a trend that will continue.
“The shortage of physicians in rural and remote areas provides opportunity for telemedicine to spread its reach to millions of patients and this widespread deployment of services will continue at a rapid pace in the future as well.” indicated Research and Markets, in its recent report Global Telemedicine Market Outlook 2020. “On the contrary, reimbursement challenges, uneven distribution of telecom network in remote areas, and high operating costs are major factors hindering its implementation.” the report found.
Greatest Challenges in Deployment of Rural Telehealth
Regarding challenges to implementation of rural telehealth, iTelemedicine spoke with Ryan Palmer of Oregon Health & Science University, School of Family Medicine. As an educator in a state with a large rural population, he identified three areas of concern facing deployment of services:
- A technology gap: “Rural doctors and healthcare providers often don’t understand the potential of telemedicine to better treat their patients,” Palmer said. “They just don’t have the time to implement these solutions.”
- The technology itself: “EHRs don’t talk to each other,” he added. “The idea that we can have all this data that doesn’t correlate, primarily because of proprietary systems, is a travesty to patient-centered care.”
- The need for easy-to-use technology: In rural Oregon, Palmer explained that they serve a large elderly population. “If the technology is more than they can grasp, it won’t be implemented.”
To gain an industry perspective on rural telehealth challenges, iTelemedicine spoke with George Tierney, COO of SnapMD, who identified four major hurdles inhibiting rural telehealth implementation:
- The availability and affordability of broadband internet service
- Access to affordable and easy-to-use devices
- Adequate supply of licensed medical professionals
- Payer reimbursement policies, especially Medicare
Fortunately, broadband services are increasing, devices are becoming simpler and more available, legislation and reimbursement issues are being addressed. Most of the barriers to telehealth implementation in primary care, chronic care, and urgent care are diminishing. What about behavioral health?
Behavioral Telehealth in Rural Regions
The U.S. Government is now acknowledging the importance of mental and behavioral support in overall patient care.
Dr. Marlene Maheu, Executive Director of the Telemental Health Institute, explains: “The Affordable Care Act (ACA) has now designated behavioral healthcare as a required part of primary care teams. The presence of a behavioral specialist is now necessary in many of the services that are compensated by Medicare and Medicaid.”
She continued: “That opens the door to many new opportunities in rural regions for people who have never had access to mental health care or never will have access, if not by telehealth. It opens many new opportunities for behavioral specialists in rural markets.“
The ACA is now pushing demand, and Medicare/Medicaid is easing reimbursement hurdles. So what is preventing the large-scale implementation of behavioral health services in rural communities?
According to a study Dr. Maheu participated in with the American Telemedicine Association, the biggest barrier was clinician billing. “The reimbursement is there; it’s available for many diagnoses that are related to behavioral care,” she said. “The problem is that the clinicians don’t know how to bill for it. They don’t understand telehealth. They don’t know the CPT codes. They don’t realize that the way to get paid is to get credentialed by the payer.”
Telemedicine technology is leaping into the future with connected, integrated home-healthcare and telemedicine platforms that allow providers to implement telehealth programs while maintaining continuity of care.
Darrell Sontag, VP of Product Marketing for Honeywell Life Care Solutions gave iTelemedicine their glimpse of this future. “We’re actively involved in implementing the ‘Medical Home’ model of the future — connecting clinicians and care teams to the patient,” Sontag explained. “With the video capability of Honeywell’s Genesis Touch, we are allowing healthcare providers to visually engage with their patients to provide a comprehensive care model out of the patient’s home.”
The Future of Rural Telemedicine
SnapMD’s George Tierney believes the future of telehealth in America will continue to be driven by improved access to care as well as convenience. “The increased adoption of low-cost mobile communication devices will enable virtual visits and remote monitoring.” He said this will “open new and cost-effective means for healthcare providers to expand their virtual care programs.”
He explained “No matter your location, a patient can receive a consult with the top specialty physician in a field via virtual visits,” he added. “As a result, the disparity of high-quality medical services can be reduced. The broader availability of medical expertise delivered via telemedicine can mean a higher quality of life for many patients and lower cost of care for society.”
So the near future is looking bright for rural healthcare thanks to telemedicine; opportunities are widening for practitioners and telespecialists to access the untapped rural market for services. Doctors who live in cities can now consult with rural patients for primary care. Distant healthcare providers can access real-time vitals of chronically ill patients via remote monitoring systems.
Legal barriers that inhibit the implementation of rural telemedicine exist, but they are rapidly diminishing. The faster we can tear down these barriers, the faster we can deliver excellent health care to underserved rural populations.
Ryan Palmer is Director of Curriculum Evaluation & Development at OHSU, School of Family Medicine and developer of TeleOSCE Simulated Telemedicine Training.
Dr. Marlene Maheu is Executive Director of Telemental Health Institute and author and speaker on legal, ethical and risk management Issues in behavioral telehealth.
George Tierney is COO of SnapMD, developer of the Connected Care telemedicine platform which enables existing healthcare systems to easily incorporate the “virtual visit” care model.
Darrell Sontag is VP of Product Marketing for Honeywell Life Care Solutions, developers of Genesis Touch remote patient monitoring device.
Access vital resources in the iTelemedicine Guide to Telemedicine in Rural Areas