CMS Report Cites Benefits, Challenges for Telehealth in Rural Hospitals

A three-year demonstration project at critical access hospitals in some of the country’s most rural regions found strong support for the use of telehealth to improve access to care.

The apparent success of the Frontier Community Health Innovation Program, run from 2016 to 2019 by the Centers for Medicare & Medicaid Services’ Innovation Center and the Health Resources and Services Administration, gives hope that CMS will continue to expand coverage for telehealth services in rural areas. At the end of the program, six of the eight hospitals involved who were using telehealth said they’d keep using connected health technology.

The Congressionally mandated program targeted 10 critical access hospitals in Montana, Nevada and North Carolina, with a goal of studying how one of more Medicare payment waivers could help those small, rural hospital improve access to care. CMS administered day-to-day operations, while HRSA focused of the operational changes and marketing to surrounding communities.

At the end of the program, those hospitals using telehealth reported high patient and provider satisfaction, as well as success with improving the community’s access to care by eliminating travel and transportation barriers. They also saw success in using telehealth to connect patients with providers for follow-up care and in connecting with specialists, particularly in cardiology, oncology and nephrology.

“CAH staff also repeatedly raised the need for more behavioral health providers who would be willing to do telehealth for patients of all ages, and several CAHs shared success stories about the impact that behavioral health telehealth services had on their community members,” the final report on the program noted.

There were also challenges. Some providers said their ability to offer specialty services was limited by what specialists were available at distant site providers. Others talked about state and federal rules that affected how telehealth encounters are scheduled and run.

“Some CAHs shared that for telehealth to fulfill its promise of improving access to care and alleviating provider shortages, more flexible arrangements to enable better access were needed,” the report noted.

And then there’s the reimbursement issue. Prior to the beginning of the project, only one hospital had billed Medicare for telehealth encounters, and during the project six of the hospitals billed for 289 Medicare telehealth encounters. In some instances the hospitals didn’t bill for telehealth services because they felt the billing process was too complicated or it didn’t offer enough in return.

The report also noted that telehealth is on the upswing regardless of CMS’ efforts, leading researchers to question whether the FCHIP helped to boost telehealth adoption. Other providers in the area who were not part of the program were also expanding their telehealth use, despite not receiving cost-based reimbursement or help with technical implementation.

That said, the program did paint a positive picture for telehealth in rural areas. It highlighted the value of community needs assessments and marketing programs to identify what telehealth services are most needed and to make residents aware of those services, and noted that both patients and providers had positive perceptions of telehealth once they used the services.

“Absolutely, we have to (continue telehealth),” a telehealth coordinator was quoted in the report. “Our patients have come to rely on it, and I know a great number of people who would simply not get services if we didn’t have telehealth.”