The Rapid Rise of Telehealth in Rural Healthcare

With many states operating under ‘stay at home’ orders and hospitals in major cities facing an overwhelming volume of patients, the COVID-19 pandemic is changing daily life in the US. Now that hospitals are delaying elective surgeries, there is a great deal of financial insecurity over lost revenue and the high cost of coronavirus care. The industry is feeling the impact at every level and senior leadership is confronting new strategic, financial and clinical questions about the future of healthcare. Each sector of the healthcare industry is facing similar challenges, while also adapting to their own unique experiences.

 

On March 30^th, the Federal Communications Commission (FCC) Chairman presented a draft order to use $200 million of the recently approved economic stimulus package to expand Telehealth services across the country. On April 3^rd, the FCC adopted the program and will use funds from the $2 trillion stimulus package that can be distributed to healthcare providers to help organizations secure broadband internet and the tech devices necessary to support Telehealth services. Additionally, the FCC approved a separate $100 million pilot program designed to offset Telehealth services for low-income patients and veterans over a three-year period. For healthcare executives, particularly in rural and critical access healthcare settings, the implementation of these Telehealth solutions play a critical role in best serving patients during this challenging time, as well as into the future.

 

Prior to the global outbreak of COVID-19, rural healthcare organizations were already struggling financially due to the geographically shifting patient population, changing Medicare reimbursements and the many rural patients lacking in high-paying private insurance. More than 120 rural hospitals closed their doors over the last decade, and those that remain open rely heavily on high-revenue services, such as lab tests, physical therapy and elective surgeries.

 

While the added financial strain created by fighting the coronavirus could prove too much for some rural facilities to sustain, many of these organizations are tackling these obstacles using innovation.

 

“The silver lining in this pandemic is the rapid forced movement to a Telehealth platform that will better position the organization for the future of virtual care,” said Bren Lowe, Chief Executive Officer for Star Valley Health in Afton, Wyoming.

 

As defined by the Health Resources Services Administration, Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. In 2019, The Centers for Medicare & Medicaid Services (CMS) increased its Telehealth reimbursement for Medicare Advantage customers, which covers more than 30% of all Medicare recipients. However, even with this increase, it is estimated only 15% of providers utilize Telehealth services as standard practice. CMS predicted this number to increase going forward, estimating that, by 2023, the Telehealth market in the US will grow to greater than $13 billion. The emergence of the coronavirus and the spreading global pandemic will change those estimations; many organizations, particularly in rural areas, are already making changes to take advantage of the available technology.

 

“Telehealth played an insignificant role in our overall care delivery model prior to the crisis,” said Greg Ruberg, President/CEO for Lake View Hospital in Two Harbors, Minnesota. “We had two agreements for Telehealth services with our system, but both were discontinued due to provider changes prior to the crisis.  We have implemented Telehealth in our medical clinic within [since the start of the pandemic] and it has taken off.”

 

“Our providers have embraced the new approach and our patients have accepted it as well. It is helping to fill the gap from significant reductions in face to face clinic visits related to COVID-19,” Ruberg said. “We are working on implementing this model for our urgent care service in our ED.”

 

In order to make Telehealth more available during the COVID-19 crisis, federal privacy regulations have been relaxed and payment policies are expanding. Prior to March 2020, Medicare Telehealth coverage was limited in scope and availability, only covering older adults living in rural areas and only covering patients who had an established provider for Telehealth care that took place in a rural healthcare facility. Now, the coverage includes office visits conducted via Telehealth technology where services are provided by physicians and or other providers, including nurse practitioners, clinical psychologists and licensed clinical social workers. Additionally, the Health and Human Services (HHS) Office is waiving Medicare’s cost-sharing requirements for COVID-19 treatment that is delivered via Telehealth from a doctor’s office or a hospital emergency room.

 

“Physicians are using various sources of Telehealth in most clinics over the last few days,” said John Bishop, Chief Executive Officer for Marcus Daly Memorial Hospital in Hamilton, Montana. “The organization is currently in the process of rolling out a uniform solution that will sustain beyond this event.”

 

Health organizations are using this technology in a variety of ways, including sharing intelligence, education and treating patients. Here are a few ways Telehealth is making a contribution:

 

While it is impossible to know exactly how hard providers have been hit at this point because the Centers for Disease Control and Prevention (CDC) has not released nationwide data, it is estimated that more than 60 infections among healthcare works have been reported. As the COVID-19 virus continues to spread, primary care providers are on the front lines. The more exposure they have to large groups, large numbers of patients, the more at-risk they become. With the use of Telehealth technology, provider organizations can divide patients into the at-risk and not-at-risk groups, allowing them to take steps to reduce the risk for both providers and patients.

 

“We have transitioned rapidly to the majority of all clinic visits being Telehealth delivered,” said Star Valley Health CEO Lowe. “This includes all primary care and specialty clinics. This will continue for the foreseeable future.”

 

Many organizations are utilizing Telehealth technology to continue to serve their well-patient population while allowing those individuals to keep a safe distance from possibly infected patient groups. For the sickest intensive care unit (ICU) patients, Telehealth services allow improved patient monitoring while keeping those patients safe from repeated contact with providers. The ability to remotely triage COVID-19 patients and to convert standard ambulatory health visits to Telehealth visits also allows providers to employ social distancing and keep patients away from crowds, while continuing to provide care.

 

Today, the capabilities of Telehealth technology provide the opportunity for enhancing the skillset of medical team members, as well as continuing to advance healthcare IT innovation overall. Most Telehealth solutions include dashboards, e-scheduling and analytics tracking capabilities that allow organizations to analyze operations at a deeper level. Telehealth can also create a virtual network, establishing opportunities for collaboration, secure communication and e-prescribing.

 

While this technology presents outstanding opportunities, education and operational change will be needed to support it. From the requirement of additional servers to training for providers and patients in using online tools, the movement toward Telehealth will require infrastructure and commitment to continue to push forward.

 

“We likely will see a patient shift toward adopting this solution,” said Marcus Daly CEO Bishop.   “Our community is one that is significantly older than average and prior to this event there was a feeling that you had to be in the room with your doctor to receive high quality medicine.  While it's hard to see out of our current mindset, I would imagine that many patients that would not have considered a Telehealth solution prior to COVID-19 will now be more open to such solutions.”

 

Prior to the immense ramping-up of Telehealth programs in 2020, many provider organizations believed older patients would not feel comfortable with virtual care; there were concerns about older patients’ familiarity with online tools and their ability to use and understand technology. Today, providers report that their older patients are increasingly comfortable with technology and are as quick to request online visits as their millennial patients.

 

The most common questions for the future now revolve around spotty access to broadband and poor cellular service in some parts of the country – particularly in remote, rural areas – as well as inconsistent access to cell phones and other technology. As these questions are answered, the path forward for Telehealth will become more clear and provide options for a much larger range of patients.

 

While the rapid adoption of Telehealth services is of great benefit to providers and patients, there continue to be hurdles to the expansion of this type of care. For example, state licensing rules stipulate that a provider can only provide Telehealth care to patients in that same state. This leads physicians to the choice between paying for multiple state licenses or finding themselves unable to treat patients in neighboring states where the COVID-19 outbreak may be more severe and access to care may be more restricted. New Jersey recently passed a law allowing New Jersey providers in good standing to see patients via Telehealth visit as long as they have an established patient-provider relationship. With cases of COVID-19 still on the rise, other states have followed suit.

 

This healthcare crisis is changing the way medicine is perceived and practiced across the world.  To provide education and support during the transition to telemedicine in rural and critical access healthcare organizations, Cejka Search is partnering with Todd Forkel, CEO of Avera St. Luke's and Avera St. Mary's in Sioux Falls, South Dakota to present a webinar on  Thursday, April 23. To register for the webinar event, sign up anytime prior to the event online.

 

“This surge of Telehealth will disrupt our industry going forward,” said Lake View CEO Ruberg. “There will benefits and risks for traditional health care organizations and we will certainly face new competition. We will have to innovate and be competitive to remain financially viable and relevant with primary care.”