Telehealth: A helpful tool for rural America in providing patient access to care

About 20 percent of Americans live in rural areas, and only 9 percent of physicians practice in those areas. This healthcare reality is forcing those areas of the country to consider expanding telehealth services as a potential solution for overcoming provider shortages and the lack of patient access to care. A House panel heard testimony last week on the current utilization of telemedicine in rural America and how increasing the use of that technology could fill the care gap and benefit those communities. 

“For the 62 million Americans living in rural and remote communities, access to quality, affordable healthcare is a major concern,” said David Schmitz, MD, president of the National Rural Health Association. 

According to Schmitz, telehealth technology can support rural delivery of care but depends on the adequate development of broadband Internet into rural and remote areas of the country. Likewise, he argued that rural providers must invest in necessary technological infrastructure and systems, emphasizing that government grants and private investment in technology “can increase the flow of new dollars into rural economies, empowering local resources to further healthcare infrastructure.”

 “Access to healthcare services can be challenging for some people, such as those who live in remote areas,” testified Nicole Clowers, managing director of the Health Care Team at the Government Accountability Office. “Telehealth can provide an alternative to healthcare provided in person or at a doctor’s office, for example, by providing clinical care remotely through two-way video.” 

Clowers noted that Medicaid and Medicare are quite different. When it comes to Medicare, she said there are several barriers to the use of telehealth including payment and coverage restrictions that limit the geographic and practice settings in which beneficiaries may receive those services, adding that these policies are more restrictive than those of other payers. 

Likewise, Barb Johnston, CEO of telepsychiatry vendor HealthLinkNow, lamented the fact that Medicare is the only health insurance payer that limits access to health care via telemedicine related to geography. And, because the Centers for Medicare and Medicaid Services will not reimburse for telehealth unless the location is in a narrowly defined “rural” location, many health facilities refuse any telemedicine programs because of concern over billing problems. 

“Medicaid doesn’t have these rules, but Medicare does,” said Johnston. “The limitation of a patient being rural or non-rural doesn’t make sense when you have a neighbor who has Medicaid and they can see a doctor, and their next-door neighbor has Medicare and they can’t.” 

“The goals were to prove this model would improve access to health care, assure patient satisfaction and reduce the per capita cost of care—these goals were achieved,” she said. “Patient satisfaction data collected by an independent third party reported that the 96 percent of patients who had received care via this telepsychiatry program would recommend telepsychiatry to friends and family, and 81 percent preferred telepsychiatry to in-person Psychiatry. Significant cost savings were also achieved.”

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