Rural hospitals are more likely than urban facilities to have access to telehealth, a once-underused service that now is playing a key role in treating COVID-19 patients, according to research by two health administration professors in Florida Atlantic University’s College of Business.

Drs. Neeraj Puro and Scott Feyereisen say the research can help U.S. hospitals understand the extent to which they are prepared for another wave of the pandemic.

WHAT’S THE IMPACT

Having telehealth provides hospitals the ability to expand their service offerings in multiple ways. It has the potential, for example, to improve outcomes for high-risk obstetric patients in rural communities. And telehealth facilitated the use of antimicrobials in rural areas where infectious disease physicians were not available.

Still, barriers such as insurance restrictions and technology limitations remain in place, for now preventing the widespread, long-term use of the service. The Centers for Medicare and Medicaid Services has issued temporary waivers to ease some of these restrictions, but these waivers are expected to expire once the public health crisis has passed, with Congressional action required to enshrine more permanent change.

Puro and Feyereisen concluded that talking with doctors remotely is an important part of improving rural healthcare in particular. The odds of hospitals to provide telehealth services vary, with Minnesota, Iowa, South Dakota, North Dakota, Nebraska, Missouri and Kansas leading the way among the nine regions designated by the U.S. Census.

What’s more, coastal states including New York, Florida, California and Washington generally lack the capability to provide e-services in rural areas, with telehealth specifically in short supply. Telehealth capabilities are more common in hospitals that belong to a system and benefit from economies of scale.

Rural populations are especially vulnerable to diseases such as COVID-19, and on top of that they may be called on to provide back-up for overflowing urban hospitals that are overwhelmed by public health crises. That positions telehealth for growth, as it’s likely to play an increasingly large role in diagnosing patients with the coronavirus. Until a vaccine is created and distributed widely among the public, it will be integral to diagnosis and treatment.

The research also found that telehealth capabilities are predictably available in larger hospitals as well as teaching hospitals, and the professors say policymakers would be wise to provide support to smaller facilities.

The study of 3,268 hospitals is based on 2017 data from the American Hospital Association survey, Area Health Resource Files and Medicare cost reports.

THE LARGER TREND

While traditionally, telehealth services have been reimbursed at a lower level than in-person visits, in March, CMS allowed for more than 80 additional services to be furnished via telehealth and for providers to bill for telehealth visits at the same rate as in-person visits. This is to apply for the duration of the emergency declaration.

Jason Popp, a partner at Alston and Bird’s healthcare litigation group, expects that a post-COVID Congress will likely first address the geographic expansion of telehealth access, with reimbursement soon to follow. After all, the model has proven especially effective in the realm of preventative care, which leads to a decrease in hospital care, and has opened up new revenue streams for healthcare facilities during a critical time.

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