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Rural Telehealth Use Rises, But Challenges for PCPs Remain

Rural telehealth use is on the rise, but primary care providers in less-populated areas still face a number of policy and reimbursement barriers.

Rural telehealth is on the up, but other telehealth barriers still exist

Source: Thinkstock

By Thomas Beaton

- Rural telehealth use has surpassed adoption in other care environments, but primary care providers (PCPs) continue to face organizational barriers when pursuing the implementation of telehealth solutions.

Research from the Journal of the American Board of Family Medicine found that PCPs practicing in a rural setting were three times more likely to have used telehealth in the past year than providers in urban settings.

Telehealth users were more likely to be located in a rural setting (26 percent vs. 15 percent), to use an electronic health record (97 percent vs. 92 percent), and to work in a practice with more than six other providers (40 percent vs. 29 percent).  

The most popular use-case among telehealth-enabled providers involved the treatment of chronic diseases. Fifty-five percent of the providers who used telehealth services in 2014 indicated they used it for diagnosis and/or treatment purposes, chronic disease management, follow-up, second opinions, and emergency care.

Providers were also more likely to refer patients to a specialist using a telehealth platform, as 68 percent of the providers who reported using telehealth services used these platforms to refer their patients to specialists. Approximately 28 percent of telehealth users referred their patients to mental health treatment providers.

However, PCPs who identified themselves as telehealth users employed the technique infrequently, with 22 percent undertaking remote consults just 1 to 2 times in 2014, and another 26 percent using telehealth 3 to 5 times within that time frame.

The researchers found that disparities in telehealth use were largely based on the type of practice, level of provider experience, and ability to actively manage potential telehealth liability.

Providers within general care practices had a higher likelihood than in speciality practices of experiencing many telehealth barriers, including cost, training, and reimbursement for telehealth services. Conversely, PCPs practicing in a private setting, an integrated health system, or in practices with some other type of practice ownership were less likely to identify reimbursement as a barrier to use.

“To address issues of reimbursement, governmental and private payers could engage in outreach efforts to increase awareness of their current allowed payments for telehealth and either expand the types of telehealth services currently eligible for payment or develop new ways to reimburse telehealth services,” the team suggested.

PCPs also faced training issues. PCPs that had more practice experience had lower barriers understanding and training others on using telehealth solutions.

Rural PCPs not only had higher telehealth usage rates, but they were less likely than other providers to say liability was a major barrier in telehealth use. Rural providers had a 33 percent lower chance of reporting liability issues in telehealth compared to urban PCPs.

“One suggestion for overcoming the training barrier is for family medicine residency programs to ensure that graduating residents are offered opportunities to use telehealth services,” the team said.

Based upon the barriers, the team alluded to the idea that amending certain telehealth policies within local and state governments can alleviate these barriers.

“If telehealth services are to have a major impact in the primary care setting, more physicians will need to become experienced in the use of these services. Many impediments to wider adoption exist; however, many of these barriers are amenable to policy modifications.”

The researchers noted that their study helps to understand the ever-growing telehealth market and patient needs. Properly understanding the provider telehealth market will help meet those needs.

“As telehealth technological capabilities improve and the demand for accessible health care services increases, telehealth represents an important venue to meet the needs of patients,” the team concluded.

“Few previous studies have examined the use of telehealth in primary care settings. To our knowledge, our study represents the first in-depth assessment of these issues using a nationally representative sample.”

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