The growth of telehealth improves continuity of care in rural communities

In Mississippi, there are just 186 physicians for every 100,000 people. There, the physician shortage—the worst in the country—strikes people in rural areas especially hard, as they face hourslong trips to reach specialists and the state's single academic medical center, in Jackson.

But that facility, the University of Mississippi Medical Center, happens to be a leader—specifically, in telehealth. Its Center for Telehealth is connected to more than 200 locations across Mississippi, a state in which the population has the highest rates of diabetes, low birth-weights and death from heart disease. Which is to say: The need for access to healthcare is great.

“Your care and your treatment shouldn't be dictated by your ZIP code,” said Michael Adcock, executive director at the Center for Telehealth at the University of Mississippi Medical Center. “We're not trying to take care of the patients here in Jackson,” he adds. “For patients, not having to leave their home community is a huge deal.”

The Center for Telehealth reaches far beyond a single institution. Of the center's sites, all but six are with organizations that aren't part of the medical center.

Indeed, telemedicine is expanding across the country, changing from something providers and patients consider cool to something they consider essential. Not only do the UMMC program and others like it increase access to care, but they also strengthen continuity of care.

SnapMD makes the virtual platform on which the visits are conducted, and providers document all visits done through UMMC's Center for Telehealth in the organization's Epic Systems Corp. electronic health record.

If a patient wants the information to go back to the primary-care physician, UMMC will pass it along. “We don't want things happening out there where a visit happens and your primary-care physician doesn't know about it,” Adcock said. What's more, that practice also allows telehealth providers to recommend local primary-care physicians—a key resource for healthier patients.

At UMMC, some providers only do telehealth visits, though most do both virtual and in-person visits. The site of care (“originating site”) and the providers (at the “distant site”) must fulfill certain requirements to receive payment from Medicare, while Medicaid coverage rules vary by state. Commercial reimbursement is spotty, and sometimes patients must pay in cash.

Providers, like patients, have been receptive to telemedicine at hospitals across the country. “In the beginning, we had providers who were a little tentative,” said Natasa Sokolovich, executive director of telemedicine at the UPMC health system. “But once they saw the positive outcomes and acceptance by their patients, that helped solidify it for them.”

Using telemedicine for consults and specialty visits saves money on both the patient and provider sides. “There's cost savings around not transferring someone,” said Mike Phillips, chief of clinical and outreach services at Intermountain Healthcare, which, through its Connect Care Pro program, links patients in rural areas of Utah to Intermountain specialists.

Patients also save money—and time—on transportation. Between 2012 and 2015, UPMC Northwest in Seneca, Pa., did about 2,000 telemedicine visits, saving patients about $233,000 in travel expenses.

For some health systems, though, those savings are hard to imagine, at least before they're realized. “A barrier is to get hospitals to realize they can have quality improvements and cost savings even though they're taking on an additional expense,” said Nathaniel Lacktman, a partner at law firm Foley & Lardner.

When hospitals and health systems do get their services up and running, the theory behind the care is relatively similar across the country. “If it's at all possible for a patient to be cared for at their home hospital, we try to keep them there,” Phillips said.

Sometimes, that means a primary-care doctor will consult with a doctor from afar while the patient is in the room. Or a patient will have a dedicated specialist visit from a doctor at a different hospital.

For all telehealth delivered in healthcare facilities, a webcam is the main tool of the trade. Other than that, the nurse or technician might use connected devices, like stethoscopes and otoscopes.

There are also analog supports. For instance, after a provider misheard “15 ccs” as “50 ccs” once, providers at Intermountain Sevier Valley Hospital now write numbers on a pad of paper that they hold up to the camera for verification.

Adcock would like to expand UMMC's telehealth program to include services for patients in their homes. It already offers in-home monitoring for patients with chronic illness, like diabetes. But it's been difficult, given the state of broadband in Mississippi, where about a third of the population lacks broadband coverage. “As we start doing more visits in the home, we're going to have to really improve the broadband across the state and country,” Adcock said. “If we can make it work in Mississippi,” he said, “we ought to be able to drive policy for the rest of the country.”

As technology, practice and policy advance, some wonder whether rural hospitals themselves will change. “There are probably a lot of services that can be done outside of hospitals,” Sokolovich said. “We're trying to figure out what that community hospital of the future really looks like. How many beds does it need?”