Piggott uses telemedicine to connect critical acute care patients with outside doctors in neurology, pulmonology and other specialties. Patients who are unable to travel to specialty doctors, many of whom are hours away by car, can connect with them through Piggott. The health system, which works with telehealth vendor Access TeleCare, has seen high levels of adoption from older patients.
“It saves a lot of people travel time and gives them easier access to specialty care in their local community” said James Magee, Piggott's executive director. “An older person can travel to our hospital and be there within a few minutes compared to having to travel two to three hours.”
Piggott's telehealth journey
Like other systems, telehealth services really caught on at Piggott during the pandemic. The technology helped care for critically ill patients who couldn’t transfer from Piggott to a hospital that typically would be more appropriate for their level of sickness. Many patients had to remain at Piggott because of capacity reasons at other hospitals, Magee said.
The health system continues to rely on telemedicine, as it still takes Piggott days to transfer patients to other facilities, said Brittnay Mossman, a hospitalist at Piggott.
"If they have to be transferred, we can still consult through telemedicine and just get that second opinion to help us take care of the patient until they are able to be transferred," Mossman said.
For health systems like Piggott, reimbursement for telehealth services helps offset the cost of the programs, both the upfront investment and the operation. Magee said the hospital receives some state subsidies for the services.
For all rural hospitals, a lack of telehealth payment uniformity across the country is frustrating. With the additional challenges hospitals face around paying for labor and supply chain costs, it all adds up.
“One of the problems with telehealth is that the payment and the regulation of telehealth is very fragmented. Some states have had their hand in regulating telemedicine and some states have more freedom to utilize telehealth,” Magee said. “What really needs to happen is Congress and [the Centers for Medicare and Medicaid Services] need to come in and set the rules that would apply nationwide."
In May, a House Ways and Means subcommittee unanimously passed the Preserving Telehealth, Hospital, and Ambulance Access Act of 2024, which would extend flexibilities another two years. The bill also would allow federally qualified health centers and rural health clinics to bill Medicare for telehealth services during that time period.
The bill, which may be voted on by the full House later this year, was supposed to receive a full markup on Thursday but lawmakers delayed it at the last minute.
Rural health providers are anxious but confident the extension will be passed, said Jason Povio, CEO of Eagle Telemedicine, a telemedicine provider. The company launched an alliance in February to help rural hospitals share the cost of physicians who provide specialty services virtually.
"I'm looking over at my calendar here and we're at the end of June and I don't see a solution," Povio said. "But we know Congress is great for acting in the 13th hour."
State-level reimbursement
Meanwhile, there is some progress on the state level. The number of states with payment parity laws, which require insurers to bill the same rate for telehealth services as in-person care, has more than doubled, to 33 states, from 16 in 2019. But many of the laws are incomplete or focus specifically on mental health, according to an analysis by law firm Foley & Lardner. New York's payment parity laws expired April 1 after the state did not renew them.
Having state-level support has helped sustain rural telehealth initiatives in states like Virginia, where there is a focus on increasing access to mental health providers. The state offers full payment parity between telehealth and in-person care and subsidizes numerous rural telehealth programs. Its five-year Rural Health Plan includes initiatives to expand telemedicine in less-populated areas.
The Commonwealth of Virginia also backs the nonprofit Virginia Telehealth Network, which operates the Virginia Telemental Health Initiative. The initiative offers free virtual mental health services to eligible uninsured or underinsured state residents, some of whom live in rural areas. It launched after policy and healthcare leaders saw the impact of the COVID-19 pandemic on telehealth adoption and how teleheath could address a shortage of mental health providers.
"We're hoping to keep folks out of crisis care, out of the emergency department," said Robin Clair Cummings, deputy advisory for strategy and quality at the initiative. "That shouldn't be a place where people receive the mental health support they need."
Virginia's funding has stabilized the program's finances but there are plans to eventually bill Medicaid for the program.
“As a state, we have codified a lot of language that is telehealth friendly and we have great state agencies that are really supportive of telehealth,” said Mara Servaites, executive director of the Virginia Telehealth Network. “It’s an interesting time to be operating in this space because I think a lot of the dust is still settling. It will be interesting to see how things shake out."
