Vrushab Gowda is a law student in the Harvard Law School Food Law & Policy Clinic and guest contributor on this blog.
In a matter of months, the ongoing coronavirus pandemic (COVID-19) has thrust telehealth into the national limelight. It has proven indispensable in delivering virtual care to patients across the country, particularly in low-resource settings across rural America. In a chasm that only continues to widen, rural healthcare has long been structurally disadvantaged relative to suburban and metropolitan regions. The reasons for this are myriad, but include a wave of hospital consolidation, the concentration of specialty providers in cities, and large distances between healthcare centers, all of which work to exacerbate health disparities.
Telehealth may offer a lifeline – sometimes in a literal sense – to the 60 million Americans who call rural counties home. Its services can offer care where little existed previously, lower costs and avert hospital readmission, minimize COVID infectious risk, and promote health equity both within and across state lines. This has not been lost on rural healthcare providers, who have steadily intensified their utilization of virtual care over the past several years.
Federal backing has played a major role in fostering telehealth initiatives in rural areas. The effort is divided across a number of departments and agencies, to include the Department of Agriculture (USDA), the Federal Communications Commission (FCC), the Department of the Interior (DOI), and the Department of Health and Human Services’ (HHS) Health Resources and Services Administration, (HRSA) among others. Aid is delivered in the form of grants and material assistance alike. Together, these federal bodies provide funding for infrastructural improvements (e.g. monitors, headsets, remote patient monitoring hardware) as well as develop, disseminate, and maintain educational resources permitting wider use of telehealth services. The 2018 Farm Bill additionally built upon these supports, appropriating $82 million in annual funding to the USDA Distance Learning and Telehealth program through the following five fiscal years.
COVID-19 dramatically underscored both the utility of telehealth and the key role of the government in encouraging its growth. It has experienced something of a renaissance owing to a series of recent regulatory flexibilities at the federal and state levels. Supported through the CARES and Coronavirus Preparedness and Response Supplemental Appropriations Acts and effected through a number of departmental waivers, telehealth services have now been made much easier for patients to access and providers to deliver. These substantive changes include expanding the list of virtual care services eligible for Medicare reimbursement, permitting their delivery through smartphones or over commonly used video chat applications like Zoom or Google Hangouts, allowing patients to receive care from their own homes as “originating sites,” rather than through a portal at designated healthcare centers, relaxing physician licensure requirements for interstate practice, and bolstering funding streams for telehealth-related programming. There is a push to make these gains permanent now that they have demonstrated their value to the American public, particularly those living in rural locations. The political will certainly exists, as evidenced by the range of bipartisan Congressional proposals introduced to this effect. It remains to be determined whether they will garner the necessary support to be brought to fruition.
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