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Best practice guide

Telehealth for rural areas
For providers Best practice guides Telehealth for rural areas

Get started with rural telehealth

Learn the basic requirements for treating rural communities virtually.

There are several ways to approach rural telehealth care. You could be living and working in a rural or frontier area and launching a new telehealth program. Or you could be located in a more urban or suburban area and expanding your practice to include rural telehealth.

There are many unique challenges for rural telehealth, from rural patient needs to technical troubleshooting to geographic remoteness. Learn how to get started with your rural telehealth program.

Challenges of rural health for patients and providers

People living and working in rural and frontier areas often face serious health disparities when compared with their urban or suburban-living counterparts.

Rural residents are more likely to die from chronic conditions, according to the CDC, including:

  • Heart disease
  • Cancer
  • Chronic lower respiratory disease
  • Stroke

The gaps span all ages ranges as well. Rural residents are generally older and sicker than urban residents, according to the CDC. And rural children with mental or developmental disorders face more challenges than their peers in urban settings.

Lack of access to healthcare is one of the top reasons for this gap. The barriers to care include:

  • Long, often prohibitive, driving distances to major hospitals, clinics, or universities offering specialized care
  • Too few local clinics and not enough providers
  • Lack of access to medical technology

Difficulties for providers

Healthcare challenges in rural and frontier locations extend to providers also. Rural practices and providers are strained by high operating costs and a pattern of hospital and clinic closures. This leaves fewer providers doing even more work.

Other challenges include:

  • An ongoing struggle to recruit doctors, nurse practitioners, physician assistants, nurses, and other providers to rural areas, especially those far outside a metro area
  • Lack of behavioral health providers to partner with on patient care
  • Higher rates of patient suicide
  • Higher number of patients with health concerns and complications from lack of access to care
  • Lower levels of health overall and complications from lack of access to care
  • Difficulty accessing critical healthcare infrastructure including electronic records, equipment, and generators
  • Few or no obstetric and gynecology services

Benefits of telehealth in rural areas

Telehealth offers a multitude of solutions to the challenges of rural and frontier healthcare. And that benefits patients, providers, and the entire community.

Telehealth benefits for patients

  • Increased access to specialists to manage and treat chronic conditions
  • Access to health and wellness programs for smoking cessation, nutrition, and weight loss
  • Increased access to mental health care
  • Fewer hospitalizations and visits to the emergency room

Telehealth benefits for providers

  • Increased provider-to-provider partnerships with larger healthcare institutions and universities
  • Access to remote patient monitoring for patients with chronic conditions such as diabetes and heart disease
  • Fewer feelings of isolation from being one of the few providers — or the sole provider — in a large, rural area
  • Increased access to training and continuing education

Financial benefits of rural telehealth

  • Less time off work for patients to visit the doctor
  • Less need for last-minute childcare for both patients and providers
  • Fewer in-person visits, which saves money for patients and providers
  • Less in-person staffing and overhead costs for providers
  • Telehealth can provide an extra income stream for providers
  • More attention on routine and preventative health to avoid the most costly health complications

Considerations for starting or expanding your telehealth practice

There are several things to consider, whether you are starting a telehealth program in a rural area or expanding your current rural practice to include telehealth.

Providers who serve rural and frontier communities include:

  • Clinicians living in the rural community they serve
  • Rural health clinics and rural federally qualified health centers
  • Solo practices
  • Urban clinicians who care for rural patients in their state or region

Familiarity with telehealth

While some have used telehealth before and others have used video chat to communicate with family and friends, some providers and patients find the idea of telehealth daunting. You will need to consider how to talk to your colleagues, staff, and patients about using telehealth for the first time.

Financial stability and sustainability

Nearly 50 percent of rural healthcare providers were facing negative operating margins before the COVID-19 public health emergency. And COVID-19 added another layer of financial strain for many. Consider grants, loans, and other financial help to get your telehealth practice started.

Federal and state laws and regulations

Clinicians who practice telehealth typically have to be licensed in the state or states where they are providing care. But there are now several ways to extend your current license to practice telehealth in other states without going through the state licensing board. This is a direct response to the increased demand for telehealth services in rural areas and the COVID-19 public health emergency.

Learn more about state and federal licensure programs affecting rural telehealth:

Find information about Medicare and Medicaid reimbursement and billing for out-of-state providers here exit disclaimer icon .

Out-of-state provider tip

Learn more exit disclaimer icon  about Medicare and Medicaid reimbursement and billing for out-of-state providers.

Telehealth modalities

Video chat may be the most commonly used method of telehealth, but there are several other ways to provide care to patients. This can be especially helpful — even necessary — in rural and frontier regions. Other telehealth options include:

  • Phone calls
  • Remote patient monitoring
  • Secure messaging through a patient portal
  • Patient-to-provider or provider-to-provider video chats from smaller, local clinics or community centers

Outreach to a rural region

If you are located in an urban or suburban area and considering expanding your telehealth practice, you will want to get to know the community you will be serving. This includes talking to local providers, meeting with community leaders, understanding their concerns, and being sensitive to their way of life.

Health equity in rural telehealth care

Health equity is defined as the opportunity for everyone to receive the health care they need and deserve, regardless of social or economic status. Telehealth is especially crucial to providing health equity in rural areas that deal with major health disparities.

Patients most affected by health disparities in rural areas include:

  • Black, Latinx, American Indian and Alaska Native populations
  • Patients living near or under the poverty line
  • LGBTQ+ patients
  • Patients with mental health challenges
  • Patients who are disabled or caring for someone who is disabled

Research shows that rural Black and Latinx report more mental health challenges, more chronic illness, and less access to healthcare than their white counterparts. These patient populations also report higher rates of obesity and smoking. American Indian and Alaska Native patients living in rural or frontier areas also have higher rates of mental health challenges and suicide, diabetes, and substance abuse.

Rural LGBTQ+ Americans have been found to have higher rates of mental health issues, including suicide. They are also less likely to receive necessary healthcare because of discrimination and stigma in many rural locations.

Read more:

LGBTQ Healthcare: Building Inclusive Rural Practices exit disclaimer icon  — Rural Health Information Hub

Racial/Ethnic Health Disparities Among Rural Adults — Centers for Disease Control and Prevention (CDC)

The role of telehealth in rural health equity

There are many ways that telehealth provides a necessary, potentially even life-saving, lifeline for underserved patients living in rural areas.

  • Providers can offer specialty care directly or patients or consult with rural healthcare providers for conditions that disproportionately affect underserved patient populations
  • Patients of color can use telehealth to connect with providers that make them feel more comfortable and safe
  • Telehealth offers more access to translation services for non-English speakers
  • Assistive technology can be made available over telehealth to patients with visual, hearing, or cognitive impairments
  • LGBTQ+ telehealth providers can prescribe necessary treatments, including mental health counseling, gender-affirming hormones, and HIV/AIDS prevention and treatment

More resources

About Rural Health — CDC

Telehealth in Rural Communities — CDC

Telehealth and Health Disparities — Agency for Healthcare Research and Quality

Rural Health Disparities exit disclaimer icon  — Rural Health Information Hub

Spotlight

Harvard Medical School Center for Primary Care

Telemedicine is a critical bridge for a growing number of rural locations that are experiencing a shortage of health professionals to treat thousands of patients. The Harvard Medical School (HMS) Center for Primary Care will serve as a hub to three rural healthcare “spoke sites.” These sites serve clinics in Arkansas, West Virginia, and the Chickasaw Nation in Oklahoma, with eventual expansion to Kentucky and Mississippi.

The program, funded by a Health Resources and Services Administration (HRSA) grant, will use telemedicine and telementoring to provide healthcare professionals in rural areas with continuing medical education certificate courses in specific diseases and conditions. The courses will equip rural health care providers to treat long-haul COVID-19 and other conditions, such as chronic lung and cardiovascular disease utilizing patient-centered and evidence-based approaches.

The clinics will also engage with HMS faculty and each other to implement quality improvement initiatives which will strengthen chronic disease management and care delivery to rural populations.

The project's long-term goals are to improve patient outcomes as it relates to long-haul COVID-19 and chronic disease management, decrease the number of specialty referrals, institutionalize quality improvement processes, and use telehealth to create a sustainable rural healthcare network.

Read more about Harvard Medical School Center for Primary Care exit disclaimer icon 


Last updated: May 13, 2022

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