Challenges to Telehealth in Rural Areas
Since the beginning of the pandemic and beyond, telehealth has been an invaluable tool for reducing barriers to healthcare in rural areas and elsewhere. It has both protected doctors and patients from virus exposure and allowed patients in medical deserts to receive care they might not otherwise be able to reach. Although telehealth services as a whole have already revolutionized healthcare accessibility for urban and suburban patients, the challenges of telemedicine administration in rural areas remain well-documented.
In the US, some of these difficulties have to do with the following:
State requirements for credentialing and licensing. Credentialing and licensing requirements for telehealth care providers vary from state to state, since with digital services, patients may not be receiving care in the same state where their doctors practice. This can cause confusion for patients and medical professionals alike and may prevent some patients from receiving telehealth services, which are designed precisely to overcome distance-related barriers to healthcare.
Medicaid and Medicare reimbursement restrictions. There is often confusion with regard to which telehealth services are covered by Medicare and Medicaid programs. The federal government regulates telemedicine reimbursement through Medicare and self-insured plans, while states regulate the same through Medicaid and fully-insured private plans. As a result, patients are frequently left wondering which services are covered and which will result in out-of-pocket expenses.
Yet some of the most significant telehealth challenges in rural areas are the same in the US and around the world. They generally fall into these six categories:
Implementation costs in rural hospitals. Rural hospitals are less likely to have foundational telehealth systems in place that allow for remote patient interaction, such as online portals where patients can access or upload records, request appointments, and send messages. This can make other tools that integrate with these systems (such as virtual appointments) costlier and more complex to implement, both in terms of initial setup and IT support, as well as staff training and patient introduction.
Limited access to telehealth infrastructure. Rural populations tend to have less high-speed connectivity, both in terms of access and adoption. In the US, lack of access is caused by the unprofitability for internet companies of building broadband infrastructure in rural areas, though other factors may apply in other countries. Rural families also struggle with the high costs of computers, smartphones, and other internet-ready mobile devices, and are less likely to view them as indispensable tools.
A need for fair and sustainable telehealth reimbursement policies. As is the case in the US, it can be difficult for governments to decide how medical providers will be reimbursed for telehealth services, particularly in comparison to reimbursement for traditional in-person services. Clarifying this is important for driving both provider willingness to offer digital services and patient willingness to use them based on their understanding of which costs are covered by insurance or government programs.
Lack of telehealth training among hospital staff. Because medical providers had to pivot so quickly to telehealth during the pandemic, corporate and government protocols around these services are still in flux. Not all healthcare workers are trained in telehealth procedures or best practices, and many will need to get up to speed on these in order to deliver consistent high-quality care to patients in compliance with national and regional laws.
A need for telehealth system quality assurance. In order for patients to consistently have high-quality telehealth experiences, it’s essential that all involved service parties provide adequate quality control and assurance. This includes elements such as reliable internet connectivity from broadband providers, effective customer service from telehealth platform providers, and consistent opportunities for patients to offer feedback on their healthcare experiences to their medical providers.
Unfamiliarity with and distrust in telehealth services among older people. Rural communities tend to be home to a higher percentage of older adults, many of whom lack training, familiarity, and comfort with internet and technology use in general. Those who do have sufficient digital literacy skills to use telehealth platforms may not trust them to be secure or effective, especially since digital tools are relatively new in healthcare.
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