By Dr. Lois A. Ritter, Teaching Associate Professor, UNR School of Public Health
Developments in procedures and prescription drugs promise improved treatments and care — but medical advancements mean little for patients who can’t access them.
Rural patients — those who live far from specialists, services and a wide pool of medical providers — have long lacked access to essential medical care. However, telehealth in rural areas is expanding health care access to connect patients and health care providers with the resources they need to diagnose, treat and manage illnesses and injuries, making care more affordable and accessible for all.
Public Health Telemedicine and Telehealth: What Do the Terms Mean?
Telehealth includes anything electronic that is related to health, such as educational websites, fitness apps and electronic health records. Under the umbrella of telehealth, telemedicine pertains to clinical endeavors — for example, a mobile app that transmits medical information.
Dr. Lois Ritter, teaching associate professor at the University of Nevada, Reno, has spent decades studying telehealth and telemedicine for rural communities. She finds the work complex and rewarding, given that telehealth is continually adapting to changes in policy. “Even the [U.S. health] agencies within the federal government define [telehealth] differently,” she says.
Dr. Ritter wants students to know that telehealth and telemedicine are essential components of public health, with the potential to provide cost- and lifesaving care to the 46 million U.S. residents living in rural areas. “[Telehealth] needs to be incorporated into the public health system — not as an afterthought [but] in the initial planning,” she says.
What Are the Benefits of Telehealth in Rural Areas?
Americans living in isolated rural settings — comprising around 14% of the entire U.S. population, according to the U.S. Department of Agriculture (USDA) — often face difficulties in accessing quality health care. People living in rural communities are more likely than city dwellers to be unemployed and low-income, and approximately 1 in 4 are covered by Medicaid. In 2019, the USDA reports, rural poverty was 15.3% — significantly higher than urban poverty at 11.9%.
With telehealth, people living in rural areas may not need to leave their homes to communicate with health care professionals and get the care they need at an affordable cost.
One of the primary benefits of telehealth in rural areas is that it can help rural Americans overcome significant barriers to care, such as:
- Geographic distance from specialists and treatment centers
- Minimal public transportation
- Health care provider shortages
Closing the Distance Between Patients and Providers
Many rural areas simply lack the health care resources to support a population’s diverse health needs. Over 120 rural hospitals have closed in the past decade, including 19 in 2019, according to the Center for Health Care Strategies.
Beyond hospitals, people in rural areas may live half a day’s drive away from specialized health care facilities, such as dialysis centers, diagnostic imaging and radiology clinics, mental health and addiction treatment centers, nursing homes, and orthopedic rehabilitation centers, to name a few.
Telehealth can connect rural patients with specialists who can monitor their conditions through video-based appointments, apps that can track biometrics (such as heart rate) and many more emerging health care technologies.
Eliminating Costly Commutes
Historically, people from rural communities have needed to commute to receive care. When the only available health care professionals are hours away in cities, taking time off work, finding child care and arranging for transportation can be an expensive logistical endeavor. Public transportation from rural centers to urban ones is often nonexistent or enormously cost-prohibitive (sometimes as much as hundreds of dollars for a 90-minute taxi ride).
All too often, individuals make hefty sacrifices to seek care so far from home. “I’ve spoken to families who have slept in their cars in 20-degree weather because they can’t afford a hotel, even with the discounted hotels from the hospital,” Dr. Ritter says. “They want to be with their loved one in their time of need.”
With telehealth appointments, families like these no longer need to uproot their lives just to seek medical care in urban centers hours away. Providing telehealth in rural areas allows individuals and families to receive care in the comfort of their homes, thereby eliminating costly commutes.
Overcoming Health Care Worker Shortages
Rural communities tend to have a more limited workforce of health care professionals, with national health care worker shortages especially affecting rural areas. In fact, these communities represent nearly 65% of primary care health professional shortage areas (HPSAs) in the U.S., according to the USDA.
How Has Telehealth Changed Since COVID-19?
Prior to the pandemic, all state Medicaid programs paid for some forms of telehealth services, such as video calls with primary care physicians. However, Medicaid did not cover many forms of telemedicine, such as “audio-only” phone calls.
With the rise of COVID-19, Medicaid programs expanded access to telehealth. Emergency policies loosened restrictions, which in turn opened greater possibilities for providers to support patients in rural areas. Some key changes include:
- Expanding reimbursable services: Allowing for a wider range of telehealth and telemedicine services (including “audio-only” phone calls) to qualify for Medicaid reimbursement
- Payment parity: Eliminating the need for states to seek federal approval to reimburse telehealth services at the same rate as in-person services
- Out-of-state provider licensing: Enabling providers to meet with patients across state lines via telehealth
Additionally, loosening telehealth reimbursement and licensing restrictions supports health care providers who choose to work with rural populations. Dr. Ritter explains that providers who may have felt isolated before telehealth options were available now have opportunities to consult remotely with specialists across the country when providing care to rural communities — creating a greater support network for doctors, nurses and clinicians.
What Telehealth Challenges Exist?
Despite the many opportunities for telehealth to connect patients with the health care they deserve, rural communities continue to face significant challenges to reaping telehealth’s benefits.
Today, the biggest obstacle to providing telehealth in rural areas is spotty internet access. People in rural areas tend to lack access to broadband internet that can support video calling, and areas with limited broadband access tend to have higher rates of chronic diseases such as diabetes, according to the Federal Communications Commission.
Limited telehealth opportunities for rural individuals can impose “a double burden where those with the lowest connectivity have the highest need,” according to 2020 research published in the Journal of the American Medical Informatics Association.
Expanding Medicaid coverage for telemedicine conducted over the phone instead of online has been one way to overcome this issue. Creative uses of technology and services can also be blended with telehealth to improve access. For example, providing mobile care clinics with Wi-Fi hotspots and other telehealth communication capabilities empowers patients to complete virtual visits from designated locations without the need to find transportation all the way to urban health centers.
Improving Patient Outcomes with Telehealth and Telemedicine
Telehealth has the ability to bridge the divide between rural communities and specialized health care providers. The U.S. medical system shouldn’t force people who live outside cities to uproot their lives to seek care. Telehealth, when fully incorporated into the thoughtful design of public health interventions, has the potential to allow people to pursue health care services in affordable and dignified ways.
By enabling people to seek medical services from home — whether preventive or palliative — telehealth and telemedicine make it possible for members of rural communities to stay connected to what matters most to them. “I spoke with a gentleman in his late 80s, and he’s like, ‘I want to die here [at home]. I want to die with my family and pastor by my side. I don’t want to die in someplace where nobody knows me,’” Dr. Ritter says. “You can’t measure that. The humanistic part is unmeasurable.”
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