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Telehealth and the CMS Rural Health Strategy

Posted by Michael Greiwe, MD | April 25, 2019 |
Michael Greiwe, MD


Is rural healthcare on the decline? The Center for Disease Control (CDC) says, from a health perspective, rural residents in the United States have the cards stacked against them.

People living in rural America have higher infant mortality rates and declining access to maternity care compared to those living in more urban settings. The American Hospital Association (AHA) reports some of the most persistent challenges faced by these communities include everything from the rampant opioid epidemic, a lack of community hospitals, workforce shortages, geographic isolation, and more. As a result, Science Daily reports 35% of the counties in the United States are experiencing significant outward population migration.

These statistics affect about 60-million people, or one in five Americans, according to the U.S. Census Bureau.

Many rural communities in the United States have been designated as medically underserved, and as such, often have a payer mix that relies heavily on Medicare and Medicaid. That’s exactly why the Centers for Medicare & Medicaid Services (CMS) developed a rural health strategy document to help improve access to care in these vulnerable communities. A key recommendation in this strategy is to extend telehealth further into these communities to increase access to care.

CMS Rural Health Strategy

“Compared to their urban counterparts, rural Americans are more likely to be living in poverty, unhealthy, older, uninsured or underinsured, and medically underserved. Additional challenges facing rural America include a fragmented healthcare delivery system, stretched and diminishing rural health workforce, affordability of insurance, and lack of access to specialty services and providers.”
From the CMS report

The CMS Rural Health Strategy document seeks to provide a framework for the improvement of care delivery in rural communities. The goals include:

  • Improve access to care by engaging and supporting providers.
    Rural healthcare providers are under incredible pressure. There is a clinical workforce shortage from reception all the way up to surgery. This stretches providers thin, particularly when staffing call coverage in rural facilities. The CMS goal includes an emphasis on providing technical assistance to clinical providers to improve care delivery. CMS also emphasized helping patients overcome barriers to access including a lack of transportation. The CMS action plan to reach this goal includes increasing training of licensed health professionals to provide healthcare in these communities and reduce the provider shortage. They also emphasize leveraging non-physician resources such as midlevels to extend clinical care. Finally, they recommend extending Medicare and Medicaid so that transportation is covered, along with providing coverage for telehealth.
  • Advance telehealth to meet the needs of rural and underserved areas lacking sufficient healthcare services.
    The strategic plan points out that telehealth has proven to increase access to care, improve the quality of healthcare outcomes, and reduce costs, particularly in the area of readmissions.
    CMS recommends modernizing telehealth reimbursement via new accountable care models and bundled payments, among other initiatives. The report stated, “To promote the use of telehealth, CMS will seek to reduce some of the barriers…such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implementing telemedicine.”
  • Empower patients to make decisions about their care.
    Many patients struggle to understand their medical bills and health insurance. Navigating today’s healthcare organizations while coping with a debilitating disease or chronic condition is challenging.
    But rural communities have additional challenges, including limited access to specialty care and long travel times to receive treatment. This makes having the right volume of information even more important to the rural patient.
    The CMS efforts to help rural healthcare providers improve in this area include the creation and dissemination of easy-to-comprehend documents to help patients understand the healthcare system that’s trying to help them.

How Can Telehealth Help Rural Communities?

The vulnerable populations in rural communities are at risk of losing access to some types of healthcare. The lack of resources leads to worse health outcomes. But telehealth shows real promise for alleviating some of the extra burdens of travel, because digital technologies can bring the healthcare providers to the patients – not the other way around.

Telehealth can be used in several ways to help rural healthcare providers who are stretched thin and patients that can’t afford the costs of additional travel to receive care. For example:

  • Remote consultations can happen faster with telehealth. Instead of waiting for weeks for a specialist appointment, a digital consult connects remote physicians with patients or two doctors together for better care continuity. The remote care can even be given via the patient’s own smartphone, which can greatly improve the customer experience. From the doctor’s perspective, these online remote consultations can help connect clinicians for second opinions but it can even help rural doctors feel less isolated from their peers in an urban setting.
  • In-home or remote patient monitoring is particularly helpful for chronic conditions such as diabetes or COPD. Monitoring these conditions from the patient’s own home via remote sensor device can decrease hospitalizations and increase patient outcomes.
  • Outsourced diagnostic analysis helps rural providers access remote specialists. Mobile imaging centers and lab specimen kiosks can take x-rays and process the films via an asynchronous telehealth connection. This is helpful for rural facilities that find it difficult to attract ancillary providers.

CMS made telehealth a cornerstone of their new rural healthcare strategy precisely because they have worked well for both providers and patients. Numerous clinical studies show that the technology has impressive returns for hospitals or other clinical providers that use these tools. Some of the benefits of telehealth include:


Telehealth and the CMS rural health strategy


For Patients

  • Improved convenience and access to care.
  • Improved engagement in self-care with remote monitoring of chronic conditions.
  • Decreased waiting time for an appointment or time spent traveling and waiting to see the clinician.
  • Decreased ER visits and hospital readmissions.
  • Cuts patient costs.
  • Improved quality of care.
  • Increased patient satisfaction.

For Doctors

  • Improved practice efficiency.
  • Increased practice revenue.
  • Reduced practice overhead costs.
  • Improved healthcare quality scores.
  • Reduced patient no-shows.

The benefits of telehealth extend beyond rural communities. For healthcare providers struggling to understand the benefits of telemedicine, consider starting the conversation with a provider like OrthoLive. OrthoLive offers a low-cost, secure, and compliant telehealth solution that helps orthopedic providers realize the benefits of these tools. Call us to find out more.

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Topics: "telehealth", "telemedicine", rural hospitals, CMS, rural health, future state

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