Top 5 Challenges in Rural Healthcare - Part 3: Regulations

This is part 3 of our blog series on the Top 5 Challenges in Rural Healthcare. Check out the other posts in this series here.

For rural healthcare providers, delivering high quality care means facing unique challenges that don’t come up in most urban settings. Many of these issues have only been exacerbated by the COVID-19 pandemic, as well. Access to care, distance, connectivity, and financial hardship are only a few of the hurdles rural health has had to grapple with. 

In the United States, rural healthcare serves one-quarter of the nation’s population. Over the last few decades, special rules and regulations were created with the aim to help rural residents get better access to care. However, some of these regulations have become counterproductive, doing more harm than good for rural patient care. 

Recently, prominent rural healthcare authorities in Georgia and Colorado Springs sat down for exclusive interviews with Pulsara to weigh in on some of the challenges that rural clinicians are currently facing, as well as some of the innovative solutions they believe can help. 

In this 5-part blog series, we will explore each of the top 5 challenges that rural healthcare currently faces, and how new technology could be key to solving some of them. Today, we'll discuss the third major challenge: Regulations. 

3. Sometimes the rules and regulations surrounding rural health do more to hinder care rather than enhance it.

Many regulations in rural health were created to help residents of rural areas get access to higher quality care. However, those rules and regulations have too often ended up hindering clinicians from doing what was best for the patient—and unfortunately, patients have suffered for it.

The history of telehealth is a prime example. Telehealth originated largely as a means of helping rural residents get easier access to care. However, many of the rules that were originally intended to help rural patients have actually hindered the flexibility of using technology to solve problems. The originating site rule, for example, set very specific requirements around where a patient had to be located for the visit to be considered a billable encounter. 

Prior to the pandemic, physicians were not permitted to offer Medicare telehealth services outside of rural areas; what’s more, these services were only covered if the patient received them at a healthcare facility. These regulations also prevented physicians from seeing patients across state lines, hindering flexibility in who can treat patients in rural communities. Restrictions around how telehealth can be practiced and where the patient must be located defeat the purpose of technology’s ability to connect providers and patients across distance. 

The issue is not limited to telehealth. Regulations surrounding where and how EMS can transport patients make already tough transport decisions more difficult than they need to be. In the midst of rural health’s many advantages, says Dr. Jean Sumner, Dean of the School of Medicine at Mercer University, regulations can sometimes prevent clinicians from making the best possible treatment decision for the patient. “We have comprehensive knowledge of each patient. We know the environment, where they are, what they do. You have the ability to have comprehensive care. What we're lacking is a system that doesn't have laws and rules that block some of those things.”

The COVID-19 pandemic has, in many ways, highlighted the need for change. Once the virus created a need for effective ways to deliver care from a distance, the U.S. Department of Health & Human Services and the Centers for Medicaid and Medicare Services (CMS) reacted quickly to loosen telehealth restrictions for the pandemic, which is helping increase access to care in rural areas. 

The strict location guidelines of the originating site rule have been relaxed, at least temporarily, which means that beneficiaries can now receive telehealth services from their home. Mobile devices and phones can also now be utilized to provide these services, and audio-only calls are now covered. More practitioners are now permitted to provide speech therapy, occupational therapy, and physical therapy (ST/OT/PT) services over telehealth, expanding the reach of all of those services—and the associated HCPCS codes and CPT codes. Virtual check-ins may now be offered to new patients, and more practitioners can now bill for these services. 

It remains to be seen whether all of these regulations will be permanently suspended, or—more likely—partially reinstated. The Telehealth Modernization Act of 2020 seeks to permanently change the originating site and geographic restrictions. If passed, the bill would allow “(1) rural health clinics and federally qualified health centers to serve as the distant site (i.e., the location of the health care practitioner); (2) the home of a beneficiary to serve as the originating site (i.e., the location of the beneficiary) for all services (rather than for only certain services); and (3) all types of practitioners to furnish telehealth services, as determined by the Centers for Medicare & Medicaid Services.” This would permanently suspend the rural-only restriction, allowing Medicare beneficiaries to receive care via telehealth from wherever they are, and not only in a healthcare facility. The American Medical Association heartily supports the bill, and has called on both the CMS and Congress to make the telehealth changes permanent. 

To explore the other top challenges that rural healthcare currently faces, check out our posts on Access to Care and Funding.