Guest Column | August 31, 2017

How Telemedicine Can Help Reduce Rural Hospital Closures And Provide Easier Access To Care

Follow-up Visits Using Telehealth

By Bobby Park, MD, Co-Founder & Director of Virtual Health, RelyMD

Since 2010, more than 80 rural hospitals have closed across the U.S. while nearly 700 are still at risk. Many reasons contribute to their downfall, but what makes it so difficult for these much-needed facilities to stay viable like their urban counter parts? Provider shortages, lack of specialized care, fewer resources, and a lower patient census are large factors that are contributing to rural hospitals being forced to close their doors.

With over 15 percent of the U.S. population living in rural areas, keeping these facilities open is extremely important, especially for those who lack the means to travel to their nearest urban hospital or health system for urgent care needs. While not the cure-all, virtual health could be one answer to many woes these rural hospitals are facing.

Provider Shortages Impact The Number Of Patients Seen And Decreases Revenue

By the year 2025, there is expected to be an overall shortage of 46,000 to 90,000 physicians and rural hospitals will feel a brunt of the hit. The small number of physicians willing to live in remote areas often contributes to the lack of providers in rural hospitals. Without the infrastructure that is available in urban areas, rural communities across the country will continue to have fewer options to pick from as they struggle to staff their facilities.

While some telemedicine platforms available on the marketplace today require a hospital or other type of healthcare facility to staff and see their own patients, often requiring more physicians and time-consuming trainings, there are many available that come pre-staffed with a range of healthcare providers. Not only does this allow a health system to see their current patients more efficiently, it allows them to expand their reach without having to hire more physicians. Hospitals that are able to implement this solution are bringing more patients to their network, increasing their revenue and patient census, without spending additional resources on hiring more staff.

One specific area where this is most helpful is in the emergency department. Emergency departments in rural counties tend to get overwhelmed with patients not experiencing true emergencies, many arriving via ambulance. Because of less available options, patients feel the emergency department is often their only choice for urgent or primary care when an unscheduled need arises. Alternatively, patients who seek urgent care needs can now access a physician from home and schedule follow-on care as needed from a more appropriate and cost-effective location with the help of a telemedicine physician.

Readmission Penalties Are Hard To Avoid When Care Is Lacking Elsewhere

According to RevCycle Intelligence, 79 percent of rural hospitals participating in the Hospital Readmissions Reduction Program in 2015 faced value-based penalties and in 2017 these hospitals are seeing a 3 percent maximum rate of penalty. CMS estimates this will accrue up to $528 million in penalties across the US. For rural hospitals already working on thin margins, a 3 percent CMS reimbursement reduction could be triggering incident that forces a rural hospital to close its doors.

Improved preventative care is a big factor when it comes to keeping patients out of the hospital, but in rural areas, this regular care can be hard to come by. Remote monitoring allows patients to check in more frequently with their physicians or nurses and also improves their ability to be seen quickly when they’re experiencing a health concern that needs attention immediately. This allows their illness to be monitored and acted upon quickly in the event of a change, reducing the chances that they’ll be readmitted to the hospital for a more serious condition.

Discharge instructions have also been a culprit of hospital readmissions. Patients, especially those with chronic illnesses, are often left to sort out lengthy and confusing discharge instructions that often include changing old medications and starting new ones. Virtual healthcare provides an affordable, convenient way for the medical system to check in on patients, to see that they understand, and are correctly following those discharge instructions, to allay their fears, and to address unexpected medical conditions since discharge.

Widespread Areas Mean Larger Patient Populations

Rural hospitals are just that, rural. Rural areas are often spread out by distance and cover a number of towns and counties, but that doesn’t mean they’re actively seeing said patients. The patient area for one rural hospital could span a number of hours of driving time. Those who live and work in the corners of these rural areas have the longest commute and those who are underserved may not have reliable enough transportation to travel the distance.

Rural hospitals who are actively providing an alternative form of care via remote consults are not only contributing to greater satisfaction rates for existing patients, they’re also expanding their reach to new potential patients who may have otherwise gone without any care at all.

Additionally, telemedicine providers and their platforms are no longer just another added doc-in-a-box facility, they are now providing hospitals and health systems the ability to offer remote care via a white-labeled app or website that is fully branded as an extension of the organization. Patients who are well acquainted with their local hospital feel more comfortable in receiving this new type of care from a brand they know. In addition, brand awareness, EHR connectivity and in-network referrals provide hospitals the ability to improve the continuity of care for all of their patients.

Providing Specialized Services In A World Of Limitations

According to the CDC, rural Americans are more likely to die from five leading causes than their urban counterparts- these are mostly chronic illnesses like heart disease, respiratory disease, cancer, and stroke. With fewer options for accessing healthcare, these chronic illnesses are harder to manage and often involve lengthy trips to an urban hospital that provides better monitoring services and the availability of specialized labs and treatments. Not only does this harm the patient who must use additional resources to access care, but the local hospital is also potentially losing a patient.

Rural hospitals can use different forms of telemedicine to improve the outcomes for their patients and reduce their own patient churn:

  1. Remote specialist consultations allow patients to connect with the nearest urban hospital and their physicians for specialized care. This saves the patients and their families’ travel costs and hours of driving time, while still retaining the patient in the local rural health system.
  2. Outsourced diagnostics provide the ability for patients to receive regular specialty lab work without traveling for hours.
  3. Regular monitoring of a patient with a chronic illness often means weekly trips to see a specialist, by being able to see and talk with the patient while they remain at home removes barriers for patients with added limitations.

Nearly 46 million US residents who reside in rural areas are facing the challenge that they may lose out on having access to high-quality emergency care and specialized services from their local hospital. Many rural hospitals are already rising to the challenge and providing direct-to-consumer telemedicine. While it isn’t an easy button, virtual care can help these organizations overcome staffing shortages, heightened readmission rates, low patient census, and patient churn.

About The Author
Dr. Bobby Park is co-founder and director of virtual health at RelyMD. Dr. Park also serves as a board-certified emergency medicine physician and has been practicing at WakeMed Health and Hospitals since 2003.