The provider shortage in rural areas is not a new problem, but what could present a challenge are the estimated 5 million net rural residents who may join Medicaid and other insurance plans by 2019, in the wake of healthcare reform coverage expansion. And as efforts increase to expand access to broadband in rural areas, telemedicine should play a key role in the solution.
That forecast is among the findings and projections in the paper “Modernizing Rural Health Care: Coverage, Quality and Innovation,” from the UnitedHealth Center for Health Reform & Modernization.
“I think the big news for rural health executives is the significant mismatch between the coverage expansion and the available capacity,” Lewis Sandy, MD, senior vice president for clinical advancement at UnitedHealth Group, said in an interview. “In many locales across the country, the largest [coverage] expansions are in the very same places where there’s the biggest access shortage in terms of healthcare delivery, particularly in remote parts of the South and the West.”
According to the paper, although the 2014 coverage expansions will place increased pressure on rural healthcare delivery, a higher proportion of rural primary care physicians surveyed said they were currently accepting new Medicaid patients (84% vs. 65% of urban primary care physicians). However, the report also finds that around 11 million rural residents currently live in areas where primary care supply is relatively low but where the increase in the insured population will be particularly high.
“There are serious access issues today, and these are going to be severely impacting rural health residents beginning in 2014, so we better get started on working out what the solutions to that challenge will be,” Sandy said.
The solutions proposed in the paper include ones that are often discussed: improved physician recruitment and retention; better organization of care through medical homes and programs that take advantage of nurse practitioners, physician assistants, and community health workers; and telemedicine and remote monitoring tools. But, Sandy adds, “This is not your grandpa’s telemedicine.”
“In the old days it required a dedicated line, dedicated facility,” he said. “Now with the push to have universal broadband connectivity in rural areas, there’s a whole new generation of telemedicine and telehealth capability that runs on that chassis of universal broadband access.”
That’s a chassis that’s still in the process of being built. According to a June report from the Federal Communications Commission, 28% of rural residents lack access to fixed broadband; that translates to19 million people without access in rural areas, compared to 7 million in non-rural areas.
“The deployment of those capabilities is spotty around the country,” Sandy said, and universal broadband access should be a priority.
Providers seem to be heeding the call. Just last week, six of the nation’s broadband providers—AT&T, CenturyLink, FairPoint, Frontier, Verizon, and Windstream—submitted a proposal to the FCC to speed broadband deployment to more than 4 million Americans living in rural areas. Also involved in the plan, which aims for connectivity within five years, are the National Telecommunications Cooperative Association, the Organization for the Promotion and Advancement of Small Telecommunications Companies, and Western Telecommunications Alliance.
As broadband access increases, so, too, should rural providers’ use of telemedicine and technologies such as cloud-based systems, Sandy said.
“Given the magnitude of the mismatch between the needs and the demand we envision and what the supply will be, we had better figure out how to be more efficient and effective in getting people the care they need, and we think that telehealth and telemedicine is a very important part of that,” he said.
Alexandra Wilson Pecci is an editor for HealthLeaders.
