December 17, 2014
Time to Transform Rural Health Care
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.