Editor’s note: National Rural Health Day is Nov. 21, 2019. Throughout the month, we are sharing stories to highlight the challenges and good work being done to improve health care in rural America. This article originally appeared in the March/April 2019 issue of the NCTC Connection.
In rural communities, the local pharmacy is often more than just a place to pick up over-the-counter cold medicine and fill prescriptions. It’s the first stop for all things health care.
“We’ve had trouble keeping doctors in our town,” says Cole Sandlin, owner of Fred’s Pharmacy in Hamilton, Alabama. “We are the first health care center for most people, and that goes for all independent pharmacies in small towns.”
Fred’s Pharmacy, independently owned since 1951, has been in the Sandlin family for three generations. Since he took over the business from his parents in 2014, Sandlin has seen people travel nearly an hour to cities like Jasper, Alabama, or Tupelo, Mississippi, just to visit a general practitioner.
So he jumped at the opportunity to install a telemedicine kiosk at his pharmacy as part of a pilot program with American Well. The company provides services connecting patients and doctors.
Installed in December 2017, the kiosk gave Hamilton residents the chance to consult with a remote physician without the lengthy drive.
The kiosk was equipped with devices to monitor blood pressure, oxygen levels, skin and ear health, and more. In short, it gave patients access to routine medical care right down the street.
“For us, it just provides another avenue in our store to help patients,” says Sandlin. “And in my little town of Hamilton, I want everybody to have the same amenities people have in bigger cities.”
A smarter approach
That gap between health care access in rural and urban areas is a challenge not just in Hamilton but throughout the country — a problem largely brought on by the rapid advancement of medical technology over the last century.
“Seventy-five years ago, when doctors carried most of what we could do in a black bag, you could have about the same care in tiny towns as you did in the big city,” says Dr. Nancy Dickey, executive director of Texas A&M’s Rural and Community Health Institute. “The reality today is it takes a much bigger patient base to pay for high-tech care.”
But thanks to modern broadband connections, patients no longer have to make a trip in person to benefit from the latest medical technology. Electronic medical records allow a specialist hundreds of miles away to stay apprised of a rural patient’s condition while the patient has remote checkups at a local clinic or pharmacy.
“What we always try to tell people is that telemedicine is not meant to replace a physician,” says Lloyd Sirmons, director of the Southeastern Telehealth Resource Center. “The whole goal behind telemedicine is to create access.”
While some rural clinics may be deterred by the idea that telemedicine requires expensive technology beyond their means, Sirmons is quick to point out that flashy setups aren’t always the answer. A remote mental health counseling program, for example, is relatively easy and inexpensive to establish.
“It doesn’t take much in the way of equipment,” he says. “I can take a laptop, one I use every day as a physician, and download software that gives me the ability to connect to a specialist. Then, I have a telemedicine unit.”
For larger health networks, broadband connectivity gives every hospital and clinic on their system access to the same quality of care. One such system is Essentia Health, which consists of 17 hospitals, about 70 clinics and eight nursing homes across Wisconsin, North Dakota and Northern Minnesota.
Since bringing on Maureen Ideker as a senior telehealth adviser six years ago, Essentia has installed videoconferencing technology at each of its locations. “They wanted to stretch scarce specialist resources to bring their expertise to rural communities, and that’s what we did,” she says.
In all, Essentia clinics and hospitals have access to about 30 specialist programs, including stroke, psychiatry and neonatal care. Larger hospitals can even partner with local pharmacies to design prescription dosages to ease patients who struggle with opioids off their addiction.
Ideker estimates that Essentia specialists see around 5,000 patients via telemedicine annually, with patients’ satisfaction improving as they have grown accustomed to the new technology. It also provides needed support for rural physicians.
“If you’re the only health provider in a rural community, that can be a pretty isolated feeling,” Ideker says. “I think they feel a lot of support from this, which makes for happier doctors who are likely to stay around longer.”
As broadband continues to open up health care opportunities in rural communities, new challenges also arise. Along with educating patients about the medical options available to them, Sirmons sees consistent insurance coverage for telemedicine and across the board as one of the biggest hurdles to its adoption.
That hurdle was enough to put an end to telemedicine at Fred’s Pharmacy, at least for now. Despite hoping to continue offering consultations through the American Well kiosk, Sandlin was forced to end the service after the pilot program concluded due to a lack of insurance coverage for users.
“We were probably a little ahead of our time, but it was an opportunity we didn’t want to miss,” he says. “We learned a lot, and we plan to have telemedicine back as soon as it’s covered.”
In fact, according to experts like Dickey, as broadband internet becomes more widespread, telemedicine won’t just be an option in rural communities. Patients will increasingly demand it. The rise of technology in medicine may be the source of the health care gap, but she believes it can close it as well.
“Not everything can be done by telemedicine,” Dickey says. “But if we can provide medical care for someone in space using this technology, we can probably close the distance between your local clinic and the next big city.”
Did you know?
Kentucky and Tennessee passed telehealth parity laws in 2000 and 2016, respectively, that require private insurance companies to reimburse telehealth services at comparable rates to in-person care. In 2016, Alabama also enacted a partial parity law to cover remote mental health services.
In South Carolina, live video consultations are covered by Medicaid in some circumstances, while Kentucky Medicaid recipients can be reimbursed for video consultations and teleradiology.
To learn more about telehealth reimbursement in your state, visit cchpca.org.