– The American Hospital Association is calling on the federal government to boost telehealth and telemedicine opportunities – including better reimbursement, financial support for new technology and improved access to broadband – for the nation’s struggling rural hospitals.
“Rural hospitals are not just access points for care, they are cornerstones of care for the communities they serve,” AHA President and CEO Rick Pollack said in a press release. “In spite of their unique challenges, providing access to quality care where and when their patients need it will always be the goal of rural hospitals.”
The recommendations are part of a report, Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care, that was issued this week. In it, the AHA notes that these hospitals are shutting down at an alarming rate for a wide variety of reasons, putting rural communities and residents in peril.
“The promise of telehealth cannot be realized in rural areas without additional governmental support for these services,” the report notes. “Federal payers should expand coverage of services and technologies; provide payment parity with services delivered in-person; assist with the expensive start-up costs of providing access to telehealth services; and cover the cost of providing telehealth at the patient’s site of care (‘originating site’).”
The AHA identifies four basic barriers to telehealth expansion in rural America:
- statutory and regulatory restrictions on how Medicare covers and pays for telehealth;
- lack of adequate broadband connectivity in some areas;
- cross-state licensure hurdles for practitioners; and
- the high cost of acquiring and maintaining necessary equipment.
The report notes that the number of telehealth visits among Medicare beneficiaries has increased dramatically, from about 7,000 in 2004 to almost 108,000 in 2013, and the Centers for Medicare & Medicaid Services is taking steps to improve coverage and reimbursement. Yet CMS continues to impede the adoption of connected care programs in rural areas through guidelines such as the originating site, which in many cases limits the delivery of telehealth services to healthcare locations, rather than clinics or the patient’s home.
“Rural hospitals often play the role of ‘originating site,’ meaning that patients still physically go to the hospital to receive a service provided from a health professional located at a distant site,” the AHA points out. “Even in cases where originating sites are eligible to bill Medicare for a telehealth facility fee, the reimbursement rates are marginal compared to the overall costs.”
The organization also called for more federal investment in broadband connectivity, a critical component to the development of new telehealth and telemedicine services. In the past, some rural states have postponed legislation supporting telehealth because legislators were concerned their hospitals and residents wouldn’t be able to access it.
“Lack of affordable, adequate broadband infrastructure impedes routine health care operations (such as widespread use of EHRs and imaging tools) and limits their availability,” the report notes.