HHS on Thursday released a plan to enhance rural healthcare services as the pandemic continues to highlight the steep healthcare barriers these regions face. But the plan falls short of the complete overhaul some experts say the problem requires, and a fair amount of the projects and directives it includes are already in place.
The 84-page plan includes steps to expand the availability of telehealth services, to link residents to non-local healthcare providers. It directs the federal government to provide more than $8.7 million in grant funding for up to 29 providers to provide emergency care consults virtually to rural providers without specialists over the next four years.
In line with the focus on emergent care, the plan calls for the administration to invest $5 million this year to recruit and train EMS personnel in rural areas. The government also wants to allow tweak network adequacy assessments to make it easier for privately run Medicare Advantage plans to manage care in rural areas.
COVID-19 has reinforced that rural issues need to be a top agency priority, HHS Secretary Alex Azar said in the opening letter to the report. A number of rural states have seen their COVID-19 case count rise over the past week, including South Dakota, Noth Dakota and Iowa.
However, though Azar said the government “cannot just tinker around the edges of a rural healthcare system that has struggled for too long,” the plan appears to mostly discuss relatively moderate seven- and eight-figure initiatives that are already underway, as opposed to a multi-billion dollar plan to remake how Americans in rural areas receive healthcare services.
Rural areas are not only plagued by a shortage of providers, but lower incomes and higher incidents of chronic health conditions compared to urban areas. The 57 million rural residents are significantly more likely to die of heart disease, cancer or stroke compared to urban dwellers. At the same time, rural facilities are closing and it’s harder to recruit physicians.
President Donald Trump signed an executive order early August directing HHS to create a report on existing and future efforts to improve rural healthcare. The project is also related to a recently announced memorandum between HHS, the Federal Communications Commission and the U.S. Department of Agriculture to improve rural broadband access.
Perhaps the boldest proposal is in the proposed fiscal 2021 budget. It would allow rural health clinics and federally qualified health centers to be allowed to furnish Medicare telehealth services, and be reimbursed for virtual care at similar rates as comparable telehealth services under the Medicare Physician Fee Schedule. CMS released the 2021 physician fee schedule early August, and added nine new permanent telehealth codes.
The rural health plan would also allow Indian Health Service and facilities run by Native American nations to receive compensation even if telehealth services are provided over state lines. Most providers are temporarily allowed to provide such services across state lines due to emergency regulations issued by HHS in the wake of the COVID-19 pandemic.
The Trump administration has also pledged $12.4 million to expand a pilot project to improve rural care for rural maternity and obstetrics patients, with expanded telehealth services.
Telehealth has potential to help reduce geographic disparities in access to care, but the administration’s somewhat myopic focus on telehealth as a catch-all solution to the rural health problem may not pan out. Telehealth relies on digital infrastructure that’s largely not in place in non-metro regions. One-third of rural households say they don’t have a broadband connection at home.
Rebecca Pifer contributed reporting.