Harnessing the Power of Rural: Expanding Access to Telehealth

November 18, 2020|3:38 p.m.| ASTHO Staff

As we celebrate National Rural Health Day this year, we are reminded of how important telehealth can be for public health and healthcare. Telehealth, the use of telecommunications technology to provide clinical healthcare, public health program services, or health education, can minimize challenges faced by rural patients and communities—such as transportation, provider shortages, etc.—manage volume, increase the quality of healthcare, and lower overall costs by reducing readmissions and avoidable emergency department visits. However, the COVID-19 pandemic has shown that access to reliable broadband is still a challenge and is a key social determinant of health for rural Americans.

Telehealth and Broadband During the COVID-19 Pandemic
The COVID-19 pandemic has brought telehealth to the forefront of clinical and policy innovation. With the need to mitigate the rapid rise in COVID-19 cases, federal agencies such as the CDC and Centers for Medicare and Medicaid Services have implemented temporary policies to expand the coverage of telehealth services. Specifically, the Coronavirus Aid, Relief, and Economic Security (CARES) Act allowed federally qualified health centers and rural health centers to serve as eligible sites of care for telehealth services during the COVID-19 response. The law also removed geographic restrictions on Medicare coverage of telehealth services, allowing rural residents to access care from any location. The CARES Act also allows providers to use telehealth to fulfill requirements for hospice face-to-face recertification.

The results of this federal legislation were profound. At the beginning of the pandemic, telehealth visits per week for Medicare recipients increased from 13,000 to a staggering 1.7 million. From mid-March to mid-June, over 9 million telehealth visits were conducted for Medicare beneficiaries. Additionally, 22% of total Medicare beneficiaries in rural areas used telehealth services. Expansion of telehealth services was also adopted by many private insurers, who saw a 4,000% increase in telehealth claims from the previous year. These dramatic increases showcase the role telehealth can play in expanding access to care, especially during a public health emergency. 

Even with an increased use of telehealth in rural areas, challenges remain. In July, HHS reported that providers in both rural and urban communities were increasingly adopting telehealth, but rural counties had a smaller uptake compared with urban counties. This suggests a possible digital divide between rural and urban communities, and illustrates how high-speed broadband connectivity is a social determinant of health—one that particularly impacts rural Americans. Broadband internet is necessary for patients and providers alike to utilize telehealth, access electronic medical records, and connect to resources that support healthy behaviors and health literacy. Pew Research Center found that rural Americans are 12% less likely than Americans overall to have broadband at home, and 24% of adults living in rural communities say access to high-speed internet is a “major problem.”

The Federal Communications Commission (FCC) mapped out the extent rural communities may face a double-burden of both a lack of broadband and of healthcare providers. To address the lack of rural broadband services, the FCC launched the Rural Digital Opportunity Fund Auction in October. This fund will provide internet companies with $20 billion in subsidies over ten years to expand their broadband networks. This is the largest investment in broadband made by the federal government to date, and it will likely contribute to increased access to telehealth in rural communities in the coming years.

State Legislation to Support Telehealth Access in Rural Communities
States are also adopting legislation aimed to improve telehealth services within rural communities. These initiatives are largely driven by the recognition that rural communities represent a vast and diverse population that require personalized care. Mississippi and Colorado are two states that have presented notable rural telehealth state legislation.

In June, Mississippi enacted a law establishing the Mississippi Center For Rural Health Innovation within the state’s Office of Rural Health. The new center is directed to provide “[t]elehealth innovation, including, but not limited to, telehealth expert consultation and telehealth development grants” to rural hospitals, critical access hospitals, rural health clinics and rural federally qualified health centers. 

In Colorado, newly enacted legislation allows for reimbursement of telehealth services in rural health clinics and prohibits insurance carriers from requiring additional certification, location, or training requirements as a condition for provider reimbursement. The law also appropriates over $5 million for the expansion of telemedicine expansion and clarifies that reimbursable telehealth services include speech therapy, physical therapy, occupational therapy, hospice care, home health care, and pediatric behavioral health care.

The Future of Rural Health & Telehealth
Telehealth can be an efficient, effective, and accessible tool that combats current and future health challenges rural communities face. The recent surge of telehealth services—and federal and state policies that emerged during the COVID-19 pandemic—have the potential to reshape access to public health and healthcare services in rural communities. ASTHO will continue to monitor the development of telehealth policy rural America and inform its members of emerging trends and impacts.


Neehar Mahidadia is a senior at Georgetown University and a health equity intern at ASTHO