Jason Povio is President and Chief Operating Officer for Eagle Telemedicine and an expert in healthcare operational excellence.
For at least a decade, there have been conversations in the healthcare and academic communities about the imbalance of available physicians in underserved markets like rural communities.
One theory was that “maldistribution” occurred due to the concentration of graduate medical training in urban areas, leading family medicine graduates to choose to begin their practice near their residencies. That contributed to a dearth of next generation physicians outside urban centers.
Fast forward 10 years, and we have a well-documented physician shortage, a pandemic-driven exodus out of urban areas, rural populations needing more specialty care services, and a more severe economic outlook as hospitals close or consolidate due to rising costs.
Adding incentives to recruit physicians to rural communities is one important aspect to better healthcare equity. Since we know hospitals are struggling with budget limitations, this will require more creative initiatives, for example, partnerships with government agencies or private foundations that can support physician recruitment and compensation in underserved areas. Also, with the redistribution of so many families now working remotely, rural area healthcare systems and government agencies need to market these communities as an affordable option for families.
The Power Of Disruption
In my view, none of the challenges to providing equitable care are going to be solved using the current operating model of many healthcare systems. It’s time to take a page from other industries and develop a new model that looks to the future of a changing demographic and technologically savvy world. I think it should include leveraging telemedicine and AI powered diagnostics to provide more sufficient, timely care to urban populations and underserved markets.
History has proven that disruptive business models do work:
• Landlines and pay phones moved toward obsolescence when Motorola demonstrated the first mobile phone in 1973. Ten years later, the DynaTAC became the first commercially available handheld mobile phone, opening the door to our current culture of iPhone and Android users.
• Picking up a DVD at your local video store became archaic when Netflix launched a mail order business 25 years ago. Now it has shut the mail order business down, having smartly captured the audience that loves to stream videos on any number of devices.
• Waiting for a taxi to be available, or using a more costly private transportation service, was no longer the only option after Uber and Lyft leveraged the popularity of smartphones and created an entirely new market of on-demand transportation. Both companies continue to innovate, offering delivery services for food and other items.
Finding An Answer To Care Equity
Like smartphones and streaming, telemedicine is disrupting the legacy model of in-person consults, enabling healthcare systems to better serve communities with technology that maps to current and future patient needs.
Pew Research estimates the share of Americans who own a smartphone is now 85%. About 75% of U.S. adults also own a desktop or laptop computer. Roughly half own a tablet. The population that healthcare professionals serve is not the DVD customer of yesteryear. It is time for healthcare systems to adopt telemedicine to align with how their patients (customers) now work and live.
Telemedicine can help alleviate the ongoing physician shortage, which is preventing care equity. Rural communities can’t compete with higher pay scale urban centers for physicians. Incorporating telemedicine helps redistribute physician talent through virtual care. With geography no longer the gating factor, telemedicine physicians can use screens and the help of trained staff to provide consults to patients in-hospital and from their clinical locations.
Hospitals can virtually add specialty staff and increase revenue by retaining patients who otherwise would be transferred to other hospitals. Physicians and staff can have relief from long hours with the added 24/7 support of telemedicine physicians.
As a service, telemedicine has gained patient acceptance. Telemedicine use remains above pre-pandemic levels, according to one year-long study: An average of 22% of adults reported telehealth use in mid-to-late 2021.
Obstacles Against Telemedicine
Further adoption of telemedicine will occur as healthcare systems and technology communication providers address these issues:
1. The ‘Digital Divide’
Broadband access, particularly in rural communities, continues to be an issue for patients who may not have the means to travel to a hospital location. It is also an issue for physicians who might want to do an in-patient consult from their clinical office. More consistent and thorough coverage remains an obstacle.
Some patients are only able to use audio, according to the Office of Health Policy study: “Persistent disparities in accessing video telehealth services requires further study on patient preferences and how broadband programs, technology resources, and technology literacy training programs can improve patient access to video telehealth services.”
2. Credentialing Delays
Across the U.S., licensing and credentialing are subject to a hodgepodge of regulations. Rural telemedicine services with limited resources “may become burdened by renewing licenses for providers to practice in several states and hospitals. In addition, states require medical licenses to be renewed periodically, typically every one to two years in rural communities,” noted the Rural Health Information Hub.
There is no universal mechanism to streamline licensing and enable multistate providers to offer telemedicine. However, programs like the Federal Credentials Verification Service offer a means of cutting through some red tape by providing a core repository of credentials for physicians and assistants.
3. Insurance Headaches
Similar to licensing and credentialing, there is no streamlined universal process for determining telemedicine coverage. Each state has its own regulations governing commercial health plans and Medicaid eligibility for telehealth. One positive note is that Medicare coverage for telemedicine is extended until 2024.
4. Physician Recruitment
Credentialing headaches, the need to get pay parity for telehealth care and the continuing challenges of broadband coverage in some communities all present challenges in recruiting physicians and furthering adoption, notably in the underserved specialty disciplines.
Telemedicine has proven it has a place in providing care equity to communities that continue to lack family medicine-related services and specialty care. The more all agencies and healthcare professionals can work together to make telehealth an economically viable and manageable solution, the more we will see better patient outcomes.
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