Health care executives have long reported interest in telehealth, recognizing its potential to alleviate barriers to access, among other challenges, in rural communities. But in rural areas, organizations have been slow to adopt these new capabilities due to low reimbursement, lack of patient interest, and inadequate internet connectivity. However, amid the Covid-19 epidemic, rural hospitals are scrambling to provide remote care as a result of severe disruption to in-person care.

Ready-to-use slides: How Covid-19 is transforming telehealth⁠—now and in the future

Rural hospitals know the risk their organizations and patients face if their communities suffer an outbreak. And evidence suggests that rural America can expect an increase in Covid-19 cases. As more rural hospitals struggle to provide care amid closures, health disparities between rural and urban areas could be exacerbated.

To address the unique needs of these organizations, rural hospitals should assess all their options as they prepare for their own Covid-19 surges. In previous blogs, we've covered how rural hospitals can address workforce shortages, secure PPE, and partner with larger institutions. This time, we'll focus on incorporating telehealth into staff workflows.

3 ways telehealth can mitigate the spread and financial impact of Covid-19

Once Covid-19 hit, CMS relaxed rules for in-home telehealth services. CMS temporarily waived HIPAA compliance protocols, allowing providers to use FaceTime, Skype, Zoom, and other video conferencing platforms for visits. The Federal Communications Commission (FCC) also awarded more than $120 million in grants to providers to support telehealth expansion through the CARES Act. This funding enables faster uptake of virtual visits, as rural hospitals don't have to invest in and set up a virtual platform. 

In the wake of these changes, rural hospitals quickly ramped up telehealth use to combat the spread of Covid-19 and recoup lost revenue from service closures—a pivot that required targeted patient onboarding to ease the transition.

Fortunately, there are three ways rural providers can use telehealth in their practices amid Covid-19.

1. Invest in telehealth to keep potential Covid-19 patients out of the clinic and limit the spread of the virus

For instance, at Shasta Cascade Health Clinic's (SCHC) Federally Qualified Health Clinics in rural northern California, residents who believe they were exposed to Covid-19 can call a clinic hotline to speak to a provider. Only after a virtual consult does a SCHC provider instruct the patient to come to a drive-thru testing facility for a Covid-19 test. A Covid-19 outbreak in a rural area would be particularly concerning for these already under-resourced communities, so protective measures such as SCHC's strategy can preserve scarce resources.

2. Implement virtual care options to offset the decline in revenue due to reduced clinic visits

Once Covid-19 hit, The Marshfield Clinic in Wisconsin quickly adapted to use video visits. Marshfield replaced about 20% of its in-person visits with virtual care and has already conducted 20,000 virtual visits since mid-March–a vast increase over its previous rate of 15,000 virtual visits annually. Use of virtual visits helped the hospital maintain a revenue stream during a time in which it would have otherwise lost even more revenue.

3. Educate patients on how to use telehealth to keep visits efficient

For many patients, this is the first time they are using telehealth. To help people living in rural areas access virtual care, Guthrie Robert Packer Hospital in Pennsylvania provides one-on-one support to patients ahead of their first virtual visit. Front desk staff call patients 24-hours ahead of their first visit to help the patient download necessary apps, test their microphone, and ensure pre-visit tasks are complete. Staff also call patients 30 minutes before the scheduled visit to check technology functionality and answer any remaining questions. They score patients based on how familiar they are with the technology and keep a record to prioritize where to direct additional support. Providing in-depth logistical support to patients during a change in care delivery—in this case, from in-person care to virtual visits—can keep patients engaged and ensure care continuity during a crisis.

Telehealth as a solution for present and future rural health care needs

In the short term, telehealth can help rural providers prevent the spread of the virus and bring back business that has decreased over the past few months. In the long term, telehealth will likely drive a shift in how providers deliver care, making these investments even more important. But barriers remain for rural providers, particularly the lack of broadband in rural areas. Some of the FCC’s $120 million in telehealth grants have reached rural providers, including the Indian Health Center of Santa Clara, FUK Behavioral Health Clinic, Ocean Mental Health Services, and Woodland Centers. These providers are using these funds to create mobile hotspots to help communities without adequate broadband access virtual care. Despite the recent FCC funding, many rural communities are still waiting for larger government initiatives to bring broadband service to the most isolated areas. 

Is your rural hospital implementing strategies to combat the impact of Covid-19? Email Darby Sullivan at sullivada@advisory.com to share your experience.