A new U.S. Department of Agriculture (USDA) telehealth report is echoing findings made over the past year by leaders of other federal agencies like the Federal Communications Commission (FCC) and the U.S. Department of Veterans Affairs (VA): Meeting the expanding demand for telehealth services in rural areas will require an increased availability of broadband connectivity.
Pointing out the potential of telehealth to allow “virtually visiting” with and remote monitoring of patients, while better engaging them to take an active role in the betterment of their own health, the authors note that these benefits are particularly useful in light of the healthcare challenges facing the nation’s more remote regions, including:
- Lack of geographic access to physicians and specialists
- A recent surge in opioid mortality rates
- Lack of funding and/or talent pools for regional and community health centers
“Some additional challenges stem from the occupational hazards found in traditional rural industries of farming and mining and the recent increase in drug-induced mortality, both of which contributed to the CDC’s finding that the age-adjusted unintentional death rate was 50 percent higher in rural areas than in urban areas,” the authors add.
USDA Telehealth Report: ‘Little Is Known’ about Use in Remote Communities
Because it’s so well suited to address many of these unique challenges, the benefits of telehealth may well be greater in rural areas than in urban, the authors explain. Yet despite this, the nation’s rural regions are lagging behind their more populous and urban counterparts in the adoption or regular use of telehealth.
For the purposes of the study, the authors refer to three basic telehealth activities commonly practiced by people aged 15 and older:
- online health research
- online health maintenance — in other words, “communication with health providers, including communicating with medical practitioners, maintaining records, and paying bills”
- online health monitoring “via devices that exchange data remotely with medical personnel”
In each of these areas, researchers found that “rural residents were less likely than urban people to engage,” with urban outpacing rural activity as follows:
- 20% of urban residents conducted online health research in 2015, compared to 17% of rural patients
- 11% of urban residents engaged in online health maintenance, compared to 7% of rural residents
- 5% of urban residents used health monitoring devices, versus 1.3% of rural residents
These gaps aren’t enormous, but they are persistent. The authors attribute them to factors like lack of access to Internet service and technology (with relatively fewer smartphones and tablets, but more PCs, used in rural areas). Earlier in 2018, the FCC came to the same conclusion that lack of infrastructure was impeding telehealth access to remote areas, with its Chairman regularly speaking on the need to boost funding for rural telehealth network infrastructure.
As Telehealth Adoption Continues to Expand, So Do Reimbursement Allowances
Meanwhile, lawmakers and policymakers alike have agreed on the need for telehealth expansion, including provisions in the 2010 Patient Protection and Affordable Care Act (ACA), the USDA/Rural Utility Service (RUS)-administered rural telemedicine program. The Centers for Medicare & Medicaid Services (CMS) loosened its reimbursement requirements for remote care in 2018, with a further expansion set for 2019.
“CMS' final Physician Fee Schedule for 2019, released last week, adds payments for a number of new telehealth services, including prolonged preventative services, virtual check-ins and evaluations of photos and videos submitted by patients,” writes Meg Bryant for Healthcare Dive. “A CMS proposal would also expand coverage telehealth services for Medicare Advantage plans.”
Yet they also see a roadblock in the effective deployment of their telehealth initiatives to the rural areas with the most pressing demands. Rural areas have historically lagged behind urban regions “in both the provision and the adoption of broadband Internet technologies,” they note, adding that, in 2015, the difference was 72% to 61% — a “a difference, which in turn, accounted for part of the rural-urban telehealth dichotomy,” they add.
After acknowledging that “not all online health monitoring technology required the high-end Internet connections more common in urban areas,” the USDA telehealth report does predict that lack of broadband connectivity will prevent the fullest, most effective access to the capabilities of the modern telehealth experience, particularly as providers and insurers continue to adopt more and more sophisticated technologies. The result is another federal agency seeking to expand telehealth funding into the nation’s most rural and remote regions.
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