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The Pandemic is Delivering the Future of Rural Health Care

The Pandemic is Delivering the Future of Rural Health Care July 6, 2020

To curb the spread of the novel coronavirus, New York State began limiting face-to-face interactions in mid-March. 

In response, local health centers and hospitals accelerated the use of virtual or remote health care, otherwise known as telehealth, which now has the potential to revolutionize the delivery of health care in rural, sparsely populated regions such as the Adirondacks. 

“The accelerated use of telehealth was an unexpected silver lining in our ‘new normal,’” said Elizabeth Rogers, the director of communications for the University of Vermont Health Network – Elizabethtown Community Hospital, which operates the hospital in Ticonderoga. 

Across the Burlington-based network, telehealth visits leapt from 60 per week to 6,000 per week, said Rogers. 

According to Dr. Kevin Gallagher of the Hudson Headwaters Health Network, that organization’s providers have held nearly 8,000 telephone consultations and have seen more than 14,000 patients via video since March 23.

Even as the health centers reopen for patients’ visits, as many as 15 to 25% of the network’s appointments could continue to be managed remotely, said Gallagher.

“The benefit to our patients cannot be over-stated,” said Kevin Dougrey, the Network’s Chief of Medical Staff operations. “Hudson Headwaters serves patients in some of the most rural areas in the state. There are several barriers to care, including significant distances between communities and weather-related issues. Providing a telehealth option is extremely important. We believe that patients will embrace this technology and that our telehealth program will grow rapidly.”

“Never let a crisis go to waste.”

According to Patti Hammond, Vice President for Physician Practice Management at Glens Falls Hospital, the possibilities of telehealth have long been obvious to the hospital’s 180-strong medical staff.

“We hadn’t gone down that road largely because the insurance companies were still struggling with how to reimburse providers for that kind of service,” said Hammond. “But at the start of the pandemic, the insurance companies stepped up and agreed to reimburse us as if that patient had actually come to the office.”

Regulations that impeded remote treatment were also relaxed, said Dr. Gallagher. 

Insurance companies even agreed to reimburse providers for telephone consultations when video consults were not feasible, said Hammond. 

Technologies that enable providers and patients to see one another, rather than just speak to one another, however, are preferred, said Dr. Rob Demuro, Medical Director for Primary Care at Elizabethtown Community Hospital. 

“With video visits, we are able to see our patients, make eye contact, read expressions. Sometimes an illness like depression manifests itself more in the style in which people communicate, not just in the words they use,” said Demuro.

Remaining Barriers to Telehealth 

According to Demuro, “The biggest barrier to telehealth has been WiFi connectivity. I don’t think I appreciated how challenging that is for some people. Some patients have to be in a particular spot, such as their lawn, to be able to connect for a video visit. It is clear that reliable and affordable internet access is integral to our future when it comes to telehealth.”

Federal funding, grants from foundations and even donations-in-kind from cable and wireless service vendors enabled hospitals and health centers to expand the use of telehealth during the first few months of the pandemic.

The hospitals and health centers now have the clinical equipment they need for video consultations, and, in some cases, for remote diagnosis and monitoring. Nevertheless, limited WiFi connectivity and access to broadband technologies remains an obstacle to the permanent expansion of telehealth, several providers said.        

“The lack of service in remote areas has been an issue,” said the Glens Falls Hospital’s Hammond.          

“Anyone who doesn’t have access to internet services and equipment can’t participate in what has quickly become the primary method of connection between a patient and their doctor,” said Saratoga Hospital CEO and President Angelo Calbone.   

Telehealth in the Post-COVID-19 Era

Although telehealth expanded from necessity, in order to prevent the spread of COVID-19, “the cat’s out of the bag,” said Hudson Headwaters’ Gallagher.                        

“In the post-COVID-19 era, there will be no going back. We’ve proven that telehealth can effectively deliver care,” he said.  

To maintain and further develop telehealth, broadband networks must expand until no gaps in coverage remain.  Moreover, the providers said, the reimbursement rates for remote care cannot be contingent upon emergencies. They must be based on reliable, lasting agreements.     Members of Congress, including Rep. Elise Stefanik, are now pushing the federal government’s Center for Medicare and Medicaid to continue reimbursing providers at the current rates for health care delivered remotely.             

And a totally wired Adirondack Park no longer seems somewhere in the distant future, said Dr. Gallagher.               

The pandemic not only revealed the potential of telehealth to care for patients remotely but also, the gaps in connectivity. Communities and families already chronically underserved by public institutions and the private sector were affected the worst, said Gallagher.

“Because the way we implemented telehealth was so widespread, we also exposed the vulnerability of those who remained out of reach.  The barriers that prevent this population from being able to access care, in the same way that everybody else is able to, have to be removed. We showed that in order to flatten the curve of the virus, broadband is a necessity. It’s no longer just ‘a nice to have,’” said Gallagher.                                                 

Gallagher said that advocacy of state legislators, county and local governments and non-profit organizations for improved broadband and internet infrastructure will ultimately be successful.        

“The push for broadband is moving along. People really are coming together,” he said. 

The Future of Health Care Belongs to Smart Machines

Gallager and Todd Young, Director of Telehealth for the UVM Health Network, however, believe that the advances in telehealth made during the months of the pandemic are merely early stages in a long term evolution in the delivery of health care. 

“This is just the beginning,” said Gallagher. “Data will be gathered from patients remotely. This is the brand new frontier of managing healthcare.”

Todd Young said, “The feedback from our physicians is that home based medical devices that share real-time and stored data will greatly improve care and quality, especially with chronic illnesses.”

“Home-generated data is a missing piece when replacing in-person care,” Young continued. “Currently, at UVMHN, we do have programs in Cardiology and Pulmonology that are doing this now, but in a limited capacity.” 

Young concluded, “We believe the COVID pandemic will be the driver to expand the use of home devices as the investment in digital health expands.”                        

According to Dr. John E. Kelly III, IBM’s Executive Vice-President whose portfolio has included research in smart health care devices, the Hudson Headwaters and UVM networks “are right on track.”

“The first phase of telehealth, simply connecting doctors with patients, while more convenient, really doesn’t change the nature of diagnosis and treatment,” said Kelly. “The second phase will be much more about collecting health data continually and analyzing the data in real time. Monitoring devices will take remote action, modifying treatments.”                                                                   

Kelly told us, “Once widespread broadband access is achieved, the remaining barriers to deploying smart health care devices are: investment; payer reimbursement; rapid but safe governmental approval of the most important devices; and an embrace of the new technologies by physicians.”                                                                   

“At IBM,” said Kelly, “we firmly believe that this is the future of health care, and we have invested heavily in it.”