Telehealth is a natural fit for rural care providers. While doctors who practice in rural areas may have limited financial and technical resources available for implementing complex systems, experts say payers are increasingly recognizing the value of telemedicine and are offering reimbursement for services.
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Experts say remote monitoring tools can help doctors do more with their time and quickly gather information from a high volume of patients. This is particularly important for doctors who practice in remote areas and whose patient populations are spread over great distances. However, few doctors who practice in rural areas have the financial resources and technical expertise necessary for implementing complicated telehealth systems.
Monica Cowan, senior public health analyst at the Health Resources and Services Administration (HRSA), said in an Aug. 17 webinar, titled Telehealth Resources for Safety Net Providers," these challenges can keep rural health care providers from getting telehealth services and systems up and running.
Monica Cowansenior public health analyst, HRSA
"Technology is fast-moving and what is available today is outdated tomorrow," Cowan said. "For most, the cost can be daunting. Equipment that is not user-friendly or effective can be the end of telehealth at a facility."
With the narrow operating budgets of most rural hospitals and health systems, any initiative that does not quickly become financially sustainable may have to be dropped, Cowan added. This has always been one of the greatest challenges facing telemedicine projects. Few payers offer reimbursements for remote services, which makes it difficult for providers to continue programs, particularly those with limited financial resources.
However, Gordon Alloway, project director at the Heartland Telehealth Resource Center in Kansas City, who also spoke at the webinar, said the reluctance on the part of payers to fund telehealth initiatives is diminishing. Medicare started reimbursing for a limited number of telemedicine services in 2001 and has since expanded the number of remote services it pays for. The accountable care organization (ACO) rules published in 2011 further expanded the number of telehealth procedures for which Medicare reimburses.
Furthermore, since state Medicaid programs typically follow the lead of Medicare, many states now reimburse for telehealth services, Alloway said. Private payers are also slowly beginning to recognize the value of telehealth. All of this should make establishing remote care programs more feasible for rural health care providers. Ultimately, patients benefit from the growing use of telehealth services, according to Alloway, as they can increase the availability of top-quality care in areas where doctors may be few and far between.
Of course, increasing reimbursement for telehealth does not remove all the barriers to its use in rural settings. Stephanie Laws, R.N., manager of the telehealth and innovative technologies department at the Lugar Center for Rural Health, a division of Union Hospital in Clinton, Ind., said in the webinar that many other hurdles remain.
"For many rural Americans, access to specialty medical care is not an option, and given the current health delivery system, the cost of accessing quality health services often exhausts available resources," Laws said.
She offered some tips to help rural providers develop successful telehealth projects. Most importantly, Laws said, providers should not believe everything vendors tell them. Every technology company will claim to have the most advanced systems and the best prices, but medical practices need to do their homework to check out these claims. "It's not the products with the loudest bell or the shrillest whistle that you should be buying," Laws said.
Health care providers also need to investigate the infrastructure available in their regions. Laws said a telehealth project may not succeed if the area has limited broadband Internet access, regardless of how well the initiative is planned. Furthermore, technology vendors rarely tell providers whether high-speed Internet is available in the practice's area.
Finally, Laws recommended workers from all parts of a practice come together as a team. A successful telehealth project will require doctors, nurses, administrative staff, technical support workers and staff to contribute. This is particularly true for rural providers who likely do not have the resources available to devote an entire department to getting a telehealth initiative off the ground.
With reimbursements for telehealth increasing, rural physicians may want to think about how they can implement remote services, Alloway said, suggesting providers look into grant opportunities available for purchasing telehealth technology. He also recommended physicians consult one of the 12 telehealth resource centers, HRSA-funded offices set up across the country to help support the adoption of remote technologies.
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HRSA isn't alone supporting telemedicine. The FDA recently announced a grant program of its own.