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Telehealth and Rural America -- The Answer to Provider Shortages?

Posted by Michael Greiwe, MD | August 20, 2018 |
Michael Greiwe, MD

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We might be reaching that tipping point between access to healthcare and serious provider shortages affecting care quality in the United States. While the residents of rural areas have been experiencing challenges tied to receiving care, the problem is about to get worse.

However, many in the healthcare industry believe that the expansion of telehealth may significantly help these rural customers. This article will look at the care access challenges we’re facing and the potential for telehealth to solve some of these problems.

Barriers to Healthcare for Rural Communities

Rural communities experience serious shortages of qualified clinical care teams and so must travel – often extensively – in order to receive medical treatment. In 2018, a new report, sponsored in part by the Center for Health Law and Policy Innovation of Harvard Law School, outlined the looming threat of healthcare provider shortages and the impact for rural areas already struggling with adequate access to care.

“The Promise of Telehealth: Strategies to Increase Access to Quality Healthcare in Rural America,” laid out four crucial issues negatively affecting access to medical treatment for our non-residential and urban areas:

● Physician shortages in rural areas.

● Low financial resources.

● Limited access to employer-sponsored health insurance and Medicaid.

● Shortages of physicians that will accept Medicaid.

It has always been difficult to attract enough physicians to serve these communities; new doctors are often faced with staggering debt from the cost of their education. Urban centers that are also hard-pressed to find talent, can simply offer better options for a physician seeking to build their practice.

The Harvard study suggested that the numbers haven’t lined up properly for decades. For example:

● Rural communities house 20% of our population but less than 10% of the clinical providers in this country.

● The number of specialists offering care is even smaller; rural residents must travel long distances both medical and dental treatment.

These communities are typically poorer than their urban counterparts, so access to reliable transportation is challenging and taking additional time off work is something most simply can’t afford. This is a crucial point; the Harvard report pointed out that 14% of the residents in rural settings live below the poverty line and per capita income is 27% lower than in cities.

But the really bad news is that these provider shortages will worsen before they ease. Medical advances have increased our longevity, which means additional long-term burdens on an already overburdened system. Too, more physicians are retiring earlier, citing the burden of regulatory pressures and other administrative complexities inherent in running a practice today.

Medical Economics reports there will be a shortfall of more than 100,000 providers in both primary and specialty care by 2030. This impact will be felt across the country, but particularly in rural areas already struggling to receive access to medical care. Compounding this is “rural flight” patterns, which will leave those in rural areas with less access to care. Doctors will simply follow these patient migrations, leaving behind rural populations for cities.

Could telehealth hold the answer for provider shortages?

The Promise of Telehealth for Rural Communities

“Rural communities face numerous healthcare challenges, including: hospital closures, lack of access to healthcare services, healthcare professional shortages and lack of culturally appropriate services.”
“The Promise of Telehealth: Strategies to Increase Access to Quality Healthcare in Rural America,”

Offering telehealth in rural communities is a crucial step toward alleviating the current dilemma and heading off future provider shortages. Offering medical treatment by using remote video conferencing through telehealth programs could:

● Bring specialist and primary care to these communities.

● Cut the costs of receiving care, including eliminating time off work, travel time, and childcare costs.

● It will help increase the number of providers tied to underserved populations in Migrant and Rural Health Centers, as wells as Federally Qualified Health Centers.

● For migrant communities, telehealth could also enable care continuity for populations that move frequently.

While many barriers to reimbursement are falling, the biggest problem with delivering treatment via telehealth in rural communities is that there is inconsistency in high-speed broadband coverage in the most rural settings. The Federal Communications Commission (FCC) says 53% of rural Americans, or 22 million people, do not yet have access to high-speed broadband service.

But telehealth can bridge gaps in service, including communication gaps, by bringing remote clinical teams and even language interpreters together to provide everything from outreach and education, to clinical monitoring, and primary and specialty care.

It’s clear that Congress is paying attention to telehealth; the Bipartisan Budget Act of 2018 lifted many of the restrictions that had been holding back telehealth implementation in rural and urban areas, including:

● Medicare Advantage providers can now offer telehealth as a supplemental benefit.

● Accountable Care Organizations participating in risk-sharing models can expand telehealth services.

● A patient’s home can now be considered an originating site for some services such as post-stroke treatment or end-stage renal disease.

● Increased funding for telehealth expansion geared toward provider shortage areas has been made available.

These steps will certainly improve reimbursement and continue to pave the way for wider implementation of telehealth treatment frameworks. But the real question is whether the expansion of telehealth services happens before provider shortages cause a real crisis in an already-overburdened American healthcare system.

Using Telehealth to Expand Access

It’s clear that telehealth is coming to a practice near you. Using video conferencing to provide treatment is nothing new; the practice is decades old. But regulatory and reimbursement restrictions have stymied efforts to expand patient access to care with telehealth services.

It seems we are in a perfect storm of provider shortages and rising costs. When coupled with the comfort level that today’s modern patient has with digital technology, it seems telehealth applications are not only suitable for today’s climate, but a necessary part of solving problems tied to providing care to everyone in our country.

OrthoLive has developed a specialty-specific telehealth application that is geared specifically toward the orthopedic practitioner. Our service is a low-cost monthly subscription that allows orthopedists to expand the reach of their practice by providing virtual house calls. Contact us to talk about our HIPAA-compliant service and how it can help your practice reach all of your potential customers.

Topics: Practice, "telehealth", "telemedicine"

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