If you’re a telemedicine advocate, you know it can transform rural healthcare. Virtual care is extending emergency services to South American villages unreachable by ambulance; it’s helping to stem the rising tide of communicable and chronic disease in Africa. In the U.S., patients in agricultural communities and remote Appalachian and Alaskan regions are receiving treatment that wouldn’t otherwise be available – at least, not without a long drive or a long wait for an appointment.
It all sounds so simple, right? But it isn’t, really. Telemedicine works best when it adapts to existing healthcare strategies. Healthcare, particularly in the U.S., can be a tangled knot of regulations, economic barriers, provider shortages and conflicting priorities between payers and healthcare networks. And it’s this intricacy that makes it impossible for telemedicine to work well in a silo. To manifest its full transformative potential, especially for the underserved, connected care must fit into current needs and policies. Examine the most successful telehealth programs today and you’ll see their orchestration is usually mapped to specific goals like capacity management or community outreach or serving Medicaid patients.
This brings us back to rural healthcare initiatives – specifically, hospitals that qualify for Critical Access Hospital (CAH) status. For these hospitals, telemedicine isn’t just a one-and-done channel for virtual visits. Instead, rural healthcare leaders are developing telehealth programs spanning their entire care ecosystem that benefits their financial health and creates a stronger legacy of care in their communities.
Strengthening Rural Hospitals
If you haven’t heard of CAH before, it’s a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS). You may be familiar with the wave of rural hospital closures in recent decades; more than 100 have closed in the last decade and another 430 are at risk, according to recent estimates. Congress created the CAH designation to reduce financial vulnerability for these hospitals while keeping clinical resources available in rural communities.
The benefits to qualifying as CAH are practical and extensive. CMS reimburses CAH hospitals differently, since they’re serving residents who live a long way from advanced care. Funding opportunities and grants are available, such as the USDA Community Facilities Loan and Grant Program – which can be used to build or improve rural healthcare facilities – and HUD Section 242: Hospital Mortgage Insurance Program, which helps rural hospitals purchase new equipment and expand their clinical capabilities. CAH hospitals also have access to resources from the Medicare Rural Hospital Flexibility Program, which can help improve emergency services, population health initiatives and operational efficiency.
But not every rural hospital is considered a CAH. To qualify, a hospital must:
- Have 25 or fewer acute care inpatient beds
- Be more than 35 miles from the nearest hospital
- Maintain an annual average length of stay of 96 hours or less for acute care patients
- Provide 24/7 emergency care services
Those are specific requirements, which is where telemedicine offers seven advantages.
The 7 Telehealth Benefits for Critical Access Hospitals
- Virtual care can connect patients to specialists who don’t practice in their area. An infectious disease expert may be needed for a local Hepatitis A outbreak; a patient with kidney failure may face transportation to another hospital that has staff nephrologists. Telemedicine can keep people in their community hospital, surrounded by family members, by virtually conferencing in the right specialist.
- That aspect also helps CAH hospitals meet their staffing requirements. While CAH must have at least one MD or DO physician, that provider is not required to be onsite – which telemedicine can facilitate.
- One of patients’ biggest complaints with rural care is the long wait for appointments. Telemedicine can radically accelerate treatment. A pediatric endocrinologist who normally only rotates through a hospital on Friday can now see a local child on Monday. A patient waiting four months to be seen at an immunology clinic can now get a virtual appointment within a week.
- Telehealth Hospital-to-Home programs are helping patients be discharged earlier while still receiving attentive follow-up care and monitoring. Home health nurses, virtual visits and connective devices that measure condition status can help hospitals keep patient stays to a minimum and hit the average length of stay of 96 hours or less.
- Connected care can drive stronger patient engagement. Whether it’s a farmer who can’t take a day off during planting season or a single mother who can’t afford the wages lost in driving three hours to a bariatric clinic, many rural patients face steep barriers to basic screenings, wellness visits and follow-up care. Telemedicine programs make it easier for these patients to proactively manage their own health, seek preventive care and avoid the higher costs of advanced conditions.
- CAH can better deliver 24/7 emergency care services with telemedicine. Someone with a third-degree burn can be seen by specialists at a renowned burn unit instead of being transferred across the state. Paramedics treating a stroke patient can immediately connect him to an expert neurologist through a telestroke program and preserve more of his functioning.
- Telemedicine also helps bigger hospitals better manage capacity. Every CAH is required to have an agreement with an acute care hospital for patient referral, transfer and transportation. These hospitals take in the patients the smaller hospital can’t treat. Through telemedicine, those providers can treat the rural patients remotely, which streamlines their own patient flows, delivers faster care and expands staff availability.
Keeping Critical Care Accessible
CAH telemedicine programs are just one way virtual care is filling care gaps. Telemedicine is uniquely flexible when it comes to connecting patients, providers and resources in a cost-effective and clinically useful manner. Given the need for durable and versatile solutions in any disadvantaged region, healthcare leaders should give virtual strategies a special priority as they write the next chapter of rural care.
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