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Primary Factors Inhibiting Telehealth Use Rural Communities

By Kyle Murphy, PhD

- State regulation and limited connectivity were major obstacles in the way of increased telehealth use in the rural communities of Mississippi, according to University of Mississippi Medical Center's Chief Telehealth and Innovation Officer.

A Senate subcommittee held a hearing on rural health which included a debate about telehealth use

In her written testimony submitted to the Senate Committee on Appropriations Subcommittee Labor, Health and Human Services for a recent hearing on rural health, Kristi Henderson, DNP, NP-BC, FAEN, revealed the primary factor inhibiting telehealth use at UMMC Center for Telehealth over its ten-plus years of operation.

First and foremost were various state laws and regulations that worked as a disincentive to using telemedicine services.

"Prior to 2013, insurance companies in Mississippi did not reimburse for telehealth consults in a way that made it an attractive alternative to a clinic visit," Henderson writes. "We argued that Mississippi would ultimately save money by reimbursing for telehealth and undertook a series of pilots to prove it. We were successful."

Changes to these regulations were instrumental in ensuring equal reimbursement to telehealth providers, referred to as "reimbursement parity, that has enabled to Mississippi to become a recognized leader in telehealth, Henderson observes.

Given the cost reductions that we have seen in Mississippi through mandated parity, I can only imagine the exponential impact of offering similar federal parity for telehealth. While increased reimbursement may cost the government more in the short term, years of data from our state and numerous others prove that the costs savings, achieved through better  chronic  disease management, fewer  ER visits and aggressive preventative care, far outweigh these  expenditures.

To sustain the state's success in leveraging telehealth services, Henderson petitioned the subcommittee to encourage the Centers for Medicare & Medicaid Services to expand telehealth testing through research and demonstration projects that prove the effectiveness and cost efficiencies of telehealth use.

Alongside reimbursement constraints, Henderson also reports the challenges imposed by limited connectivity in Mississippi:

Due to the largely rural nature of our state, we could not take for granted that support for telehealth services would be available at the level we required, or frankly, at all. In order to achieve the connectivity required, we partnered with telecommunications companies from around the state to maximize existing resources and leverage the strength of incumbent utilities in the areas where they serve. Thanks to support from the Universal Service Fund and our partners across the state, we are able to bring much needed, life changing health care to rural Mississippi. 

In looking to the future of telehealth use, Henderson called on the subcommittee to consider four issues:

1. The need to test reimbursement parity at the federal level, particularly for remote patient applications.

2. The need for continued and coordinated federal support for telehealth infrastructure development, workforce training and demonstration projects.

3. The need to remove geographic barriers for reimbursement.

4. The need for continued support of USF.

Henderson's testimony as well as those of other witnesses, including representatives from CSM and the Health Resources and Services Administration, are available here.

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