Rural hospitals need more than telehealth to survive the pandemic

Leaders from Geisinger, Dartmouth-Hitchcock and other health systems say wholesale "transformation" is needed to help providers and their patients weather this storm.
By Kat Jercich
03:25 PM

Rural hospital leaders say COVID-19 has magnified the need for access to telehealth – and that it's a mistake to rely on one-size, fits-all solutions for virtual care.

During a Thursday webinar hosted by the Bipartisan Policy Center and moderated by former Sen. Tom Daschle, D-South Dakota, hospital leaders from around the country explained how the coronavirus crisis has exacerbated existing challenges faced by rural health systems.

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"We talk about geography [as a factor] ... but changes in healthcare delivery over the last 20 years" have contributed to a shortage of resources and providers, said Geisinger Executive Vice President and Chief Innovation Officer Karen Murphy.

"We've evolved over the last two decades to decrease, nationally, inpatient admissions," Murphy said. Now, admitted patients "require very complex, specialized sophisticated technology and a host of specialists to take care of [them]" - specialists who may not be easily recruited in rural areas. 

Since January 2010, 126 rural hospitals have shut down, with nearly 600 more on the brink of closing. This directly affects the provision of services to a population that tends to be older, sicker, and less insured than the general public. 

Without facilities nearby, patients have to travel long distances to access care – which can cause even more challenges, such as when care is restricted based on hospital religious policies

"Many areas we provide care to did not have much recovery since [the economic crash of] 2008," said Marshfield Clinic Health System CEO Dr. Susan Turney. 

A report published by the Bipartisan Policy Center in advance of the webinar noted that the steps taken to make services more accessible amid the coronavirus pandemic could be made permanent in order to improve rural healthcare access.

"In March 2020, as coronavirus evolved into a pandemic, Congress voted to temporarily waive telehealth requirements for Medicare providers, allowing the Centers for Medicare and Medicaid Services, or CMS, to reimburse clinicians for telehealth visits with patients at home in an area with a designated emergency," the report read.

"The Trump administration has built on this effort and temporarily expanded access to care by providing regulatory flexibility around the use of telehealth for all Medicare beneficiaries." 

Healthcare leaders agreed that the relaxed telehealth regulations should be made permanent.

They also pointed out that providers can use telemedicine to communicate with others when patients are too sick to be transported. 

"The future of rural healthcare is using provider-to-provider support so they can keep patients in the facility and care for them appropriately," said Dartmouth-Hitchcock Health Care System CEO Dr. Joanne Conroy. 

However, many pointed out that broadband Internet access continues to be a concern in rural areas.

About 20 to 25 percent of Marshfield patients don't have broadband, said Turney, and about 60 percent of virtual visits are through telephone. 

"Those patients really needed that touchpoint, but we have a long way to go to be able to deliver the service I think that everyone will expect," she said. 

"It isn't just ambulatory care; [telehealth] needs to extend into home health, into hospital at home, into other home nursing care," Turney added. 

Although she said patient satisfaction with telehealth services is high, she also noted that telehealth should involve "working with our public health institutions and connecting dots across the whole ecosystem to really leverage the technology to do what's best for our patient care." 

When it comes to remote monitoring technology, leaders urged attendees to remember that patients may not be able to afford the necessary devices, or the monthly fees to maintain connectivity.

In addition to improved access to virtual services, the panelists pushed for changes in payment models to allow rural systems to control costs. 

"What we should all be talking about now, looking at the last two months and how we go forward, is truly transformation," said Murphy. "In order to achieve that transformation in a rural setting, we are gonna need to deliver health care in a digital way."

"Our theme coming out of COVID should be 'transformation, transformation, transformation.'"

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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