I need to start this with a statement
that I think my definition of rural healthcare differs from the
definition used in this article. The article uses 19.3 percent as
the number living in a rural area, and says only about 10 percent of
physicians practice in rural areas. The article also declares that
65 percent of all Health Professional Shortage Areas are in rural
areas. It is small wonder that many must travel long distances to
see a specialist after months waiting for an appointment.
Even in areas where rural primary care
providers (PCPs) remain committed and engaged in the community, often
having been raised and educated there, these providers often lack
close connections to specialists who tend to be based in larger,
urban academic medical centers (AMC). The result is a worsening gap
in specialty care access, in turn leading to a deteriorative effect
on rural provider morale and retention.
Much of this is because many local
hospitals are being bought out by regional hospital groups and
becoming larger and more incapable to serving rural primary care
providers (PCPs). We are seeing this in our community and now the
local hospital sends many patients out to other hospitals. What is
disturbing is that most patients are transported by medical
helicopters at added costs rather that by ambulance which still are
expensive, but about a tenth of the cost of a helicopter.
Most of the efforts to improve rural
care have focused on enhancing the patchwork of federally regulated
safety net programs, with the goal of increasing quality of care by
increasing access to primary, routine, and emergency care.
Innovative communications technologies, decision support tools, and
initiatives to enhance “broadband” access in rural areas are
enabling some frontline rural health care professionals, and even
patients and family members themselves, to implement new approaches
to delivering high-quality care even with limited availability of
physicians, and particularly expert physicians.
I do not
understand why authors of many articles dance around the issues.
Telemedicine and its use are not new technologies – just underused
technologies that many third party payors (medical insurance
companies and Medicare) do not want to pay for and constantly put
obstacles up to stop its use.
Some states are attempting to install
high-speed internet lines, but the political issue is being lobbied
heavily against from many businesses and internet providers. In
addition to improving quality and capacity of care within rural
communities, these approaches also have the potential to generate
cost savings. Receiving more specialized treatment from a PCP may
reduce complications and emergency department visits, as well as the
volume of costly and unnecessary referrals to tertiary centers.
Provider education and electronic consultation approaches may also
provide cheaper ‘junior’ specialty care as this dissemination of
knowledge enables PCPs to provide more care themselves.
Yes, telemedicine can do this and more.
Yet, despite this potential for improved care and cost savings, the
United States health care system is not set up to recognize and
reward these approaches. Because they represent a traditional health
care facilities and in-person consultations and services, they are
often not supported under traditional fee-for-service payment systems
like Medicare.
Changes are supposed to happen under
the Affordable Care Act, but many of the provisions are being
postponed by the President or his Health and Human Services
department. However, until our Congress decides that rural
healthcare is important, very little will be accomplished. Funding
of telemedicine to obtain the cost savings many know has potential
will not happen until Congress does something positive to force the
insurance industry to support telemedicine.
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