Rural Health and Telehealth: Six Takeaways in Health

The COVID-19 crisis has led Congress and the Administration to implement legislative and regulatory changes that have expanded Americans’ access to telehealth services that are provided through Medicare. These changes have been particularly beneficial for one of the U.S.’s most vulnerable communities: rural America. Even before the virus, rural America’s population struggled to access the healthcare it needs due to travel expenses, hospital closures, difficulties recruiting and retaining a health care workforce, and more. Because telehealth services have been considered a potential solution to improve rural healthcare access, the recent changes to telehealth regulations can offer many important long-term lessons. Recently, the Bipartisan Policy Center hosted a virtual discussion on telehealth and COVID-19 in rural areas to discuss the current situation and the potential for long term growth in telehealth services. Here are some of BPC Action’s key takeaways. 

Regulatory changes are essential for long term telehealth solutions

During the discussion, the panelists highlighted two specific regulatory changes that have been beneficial for physicians providing telehealth services: reimbursement rules and license flexibility. Under the new regulations, doctors are reimbursed by Medicare for telehealth visits at the same cost as in-person visits. This has made it more financially feasible for more physicians to offer telehealth services. 

Moreover, reimbursement for telehealth services has been expanded to allow doctors to be reimbursed for serving patients in their homes via telehealth. This change has been particularly helpful for rural communities as travel often keeps patients from seeking the help that they need. 

In addition, states and the federal government have relaxed licensing requirements to allow doctors to provide care outside the state in which they hold their medical license. This has allowed physicians to reach a greater number of patients through telehealth and allowed communities with provider shortages to tap into robust physician networks. 

Overall, the panel discussed the benefits of these reimbursement and licensing changes for improving patient access to care and the potential for long-term benefits if we use this opportunity to examine what changes should be made permanent.

Cost projections are more complicated than meets the eye

Telehealth has given rural Americans increased access to the health care they need. However, in part due to this expanded access, long-term cost projections of a permanent telehealth expansion remain a challenge to implementation.  Those cost projections represent the costs that are borne by payers like Medicare, Medicaid, and private insurance, and do not take into account the savings from telehealth related to time and travel for patients. Overall, this means that cost projections of telehealth don’t fully reflect the benefits of these services, but policy makers will have to consider whether to take these personal savings into account when considering federal and state costs. 

Aging into telehealth 

People have questioned if our older population is technologically savvy enough to navigate the telehealth system. However, due to the varied types of technology used and older generations’ increasing experience with newer technology used as a way to connect with their families, the telehealth system is more easily navigable than one might think. What’s more: as our population ages, telehealth might become what older Americans expect. Introducing telehealth services into the market now may be a learning curve for a part of the population, but in twenty years these initial steps will be necessary to meet the new marketplace’s demands. Long term solutions using telehealth require that future populations’ needs are strongly considered. 

Telehealth does not compromise quality

Because telehealth offers a new form of connecting to patients through technology, the quality of care has come into question. However, during the discussion, physicians strongly emphasized that the quality of care acquired through telehealth is equivalent if not better than in-person checkups. One panelist remarked that being able to speak and connect with their patient directly elevated her experience. Moreover, she reported that telehealth helped prevent a surge of coronavirus cases by allowing sick and healthy alike to avoid in-person contact, which is extremely important when considering the overall well-being of patients during this time.  

Access to mental healthcare has improved 

Telehealth has improved mental health care on many fronts. For one, being able to access mental health care resources virtually has allowed more people to access the critical care they might need. In rural communities, the anonymity that virtual healthcare provides has been enormously beneficial in people’s willingness to seek care. 

Meanwhile, telehealth work in schools has allowed health care providers to assess and connect children to the services they need more efficiently while reducing the time that parents need to take off from work. By connecting individuals and children to the care they need quickly, telehealth has the ability to improve long-term mental health.  

Congressional action will be influenced by the new data coming out of the pandemic

Although the changes made to expand telehealth are temporary, the data that is being gathered that demonstrates the positive effects of telehealth during this crisis can be used later on as a catalyst to make legislative change. This information helps paint a clearer picture of what steps may be necessary to make a permanent expansion of telehealth possible. Because Congress can now see critical data—about both the benefits, including patient satisfaction, and the challenges, including the need for improved technological infrastructure in certain places—they have a starting point for designing permanent solutions.