A new plan released by the US Department of Health and Human Services (HHS) earlier this month calls for improving rural health care services, especially by facilitating the expansion of telehealth in rural communities.
Even before the coronavirus disease 2019 (COVID-19) pandemic, health care in rural areas has struggled with a number of longstanding challenges, including clinician shortages and closing of rural hospitals—130 closures since 2010, with 13 closures through July this year, according to the American Hospital Association. Residents of rural areas are more likely to report less access to health care and lower quality of health.
The Rural Action Plan, released in response to a presidential executive order in August calling for improved rural health and telehealth access, presents strategies aimed at addressing current barriers to providing rural health care. The plan cites “leveraging technology”—most prominently, telehealth—as a key strategy to facilitate more efficient and cost-effective delivery of quality care to rural areas.
The plan notes that the Trump administration’s proposed fiscal year 2021 budget would expand Medicare’s telehealth benefit to rural communities by permitting rural health clinics and federally qualified health centers to provide telehealth services. Such care would also be reimbursed at rates similar to payment for comparable telehealth services under the Medicare Physician Fee Schedule.
“This proposal would level the playing field by allowing these health care facilities to participate more broadly in the existing Medicare telehealth program,” the plan notes. “It would also increase beneficiaries’ access to care in rural areas where these clinics and centers are often the only source for primary care.”
The fiscal year 2021 budget also includes a legislative proposal to expand access to Medicare telehealth services for Indian Health Service and tribal facilities. This proposal would allow such facilities to bill Medicare for telehealth services provided across state lines—a practice that emergency regulations issued by HHS currently permit because of the COVID-19 pandemic.
The Coronavirus Aid, Relief, and Economic Security Act, passed in response to the COVID-19 crisis, allows federally qualified health centers and rural health clinics to serve as distant sites for telehealth during the COVID-19 emergency period. Also, the Centers for Medicare & Medicaid Services passed emergency waivers that helped rural facilities get more funding, including for telehealth services, although those waivers will expire when the coronavirus emergency ends.
Part of the focus of telehealth services involves providing emergency care, with the Federal Office of Rural Health Policy investing approximately $8.7 million over 4 years to support up to 29 new organizations to promote rural tele-emergency services. “The program aims to promote rural tele-emergency services by enhancing networks’ capacity to deliver 24-hour [emergency department] consultation services, without emergency care specialists, via telehealth,” the plan notes.
In a statement announcing the plan, HHS secretary Alex Azar said, “We cannot just tinker around the edges of a rural healthcare system that has struggled for too long.” However, in a report by Kaiser Health News, some experts said that telehealth was “short on funding in the HHS initiative” and that it “will be a long time” before the necessary infrastructure and technology will be readily available to much of the country.
The plan itself acknowledges that broadband internet access—necessary infrastructure for many telehealth efforts—is a concern with respect to efforts to expand use of telehealth in rural areas: “HHS recognizes further investments in broadband may help bridge the gaps between rural and urban areas and reduce geographic isolation.”
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Stephenson J. Federal Plan Proposes Improving Rural Health Care Through Telehealth. JAMA Health Forum. 2020;1(9):e201186. doi:10.1001/jamahealthforum.2020.1186