The Rural Telehealth Research Center (RTRC) recently published a research and policy brief titled “Organizational Factors Associated with Using Telehealth Services: Perspectives from Leaders of Rural Health Clinics and Federally Qualified Health Centers.” The paper, which contains the findings of interviews conducted with leaders in rural health clinics (RHCs) and federally qualified health centers (FHQCs), focused on the challenges, trends and resources needed to provide services via telehealth in their clinics. The interviews were conducted between May – September 2024. Interviewees included leaders and staff of a select sample of RHCs and FQHCs who volunteered for this study and were located in six states: Michigan, Missouri, Nebraska, Vermont, Virginia and Washington. A total of seven FQHCs and 10 RHCs were involved in the interviews.
The paper notes that the public health emergency (PHE) had a significant impact on the ability of RHCs and FQHCs to utilize telehealth to provide services. Pre-PHE FQHCs and RHCs could only act as the originating site (i.e., where the patient is located) under the Medicare program. Additionally, the RHC or FQHC had to be located in a rural area (as defined by Medicare), which further limited the eligibility of an originating site. To address the health care needs of the population during the PHE, temporary policies were put into place waiving the rural originating site requirement as well as allowing FQHCs and RHCs to also act as a distant site provider and be reimbursed by Medicare for those services (these waivers have since been extended to September 30, 2025 by Congress). Many FQHCs and RHCs took advantage of the temporary waivers during the PHE and worked to expand their telehealth programs and began to utilize technology to provide services to their patients. However, the adoption of telehealth requires time and resources, and doing so during a pandemic presents additional challenges, as does the building of experience for providers and patients in delivering and receiving, respectively, services via telehealth. All of these factors helped shape the responses the interviewees of this study provided.
Certain themes emerged within the interviewee’s responses, including:
- Patient preferences are drivers of telehealth services: A patient’s preference can strongly influence the practitioner’s decision on whether to use telehealth and, even though telehealth may allow for the patient to be seen sooner, many patients may still opt to wait for an in-person visit.
- Providers adapt to new technology when it is easy and useful but prefer “in-person”: Some who are newer or late “adopters” of telehealth have cited a preference for having maintenance and technical support which would help, or increase their willingness, to use telehealth more frequently. However, even more experienced telehealth providers have noted that there often remains a need for some services to include an in-person interaction.
- Organizations can influence telehealth use by adequate preparation and support: Adequate preparation of providers and patients will impact the successful uptake of telehealth. As noted above, providers’ unfamiliarity with telehealth can lead to hesitation in adopting it for providing services. Additionally, patients who have never received services via telehealth before may also be less willing to have their needs addressed via technology. Adequate pre-preparation for both patients and providers would help to minimize issues and create a better experience for both parties. This study notes that some strategies to help facilitate the transition into telehealth delivered services, for both the patient and the provider, include elements like working with practitioners and their staff prior to telehealth implementation to help identify any potential concerns and proactively work on solutions for them, such as the adjustment of workflows. Other suggestions include offering support to address operational issues, such as scheduling and/or follow-ups. There were also interviewees who noted that some of the preparations made within their facilities helped to optimize provider/staff scheduling and balancing workloads as unexpected benefits to preparing for the use of telehealth.
- Technological capability, beyond the organization, is a significant constraint: The interviewees flagged broadband connectivity and other technology limitations, such as a patient’s ability to learn to use the necessary features of a cellphone for the telehealth visit, as another issue. When a patient comes into the clinic acting as the originating site, these issues are usually alleviated, as the clinic will have adequate connectivity arranged and staff will be available to assist the patient throughout the visit. However, if the patient is at home or another location, issues can occur that could lead to frustrations for both patient and provider.
- Funding drives organizational behavior: As with other providers, FQHCs and RHCs have also noted the importance of billing and reimbursement as a major factor in using telehealth to provide services. FQHCs and RHCs, like other providers, identified billing and reimbursement as a key factor in telehealth adoption. Current policies are often complex, unclear, and difficult for clinics to navigate. Interviewees emphasized the need for reimbursement rules to be clearly defined and communicated—especially given the uncertainty around the future of Medicare's temporary telehealth waivers.
- Interviewees also noted that despite what the policies might be for reimbursement/coverage, they need to be well-defined and clearly communicated.
The study ultimately notes that there is value in using telehealth to provide services. This includes innovation around providing care, the quality of care being delivered, and all-around efficiency. It was also noted that telehealth allows an opportunity to provide practitioners with more information about the patient’s home environment which can help to inform the treatment plan, and can also allow for new technology to help with home care monitoring. However, it is also important to note that sometimes the technology can result in providing less efficient care, or concerns over quality of care provided may arise, as technical and connectivity issues can significantly impact the quality of a visit with a patient. Providers also expressed concern as to the possibility of missing something in a telehealth visit that they likely would not have during an in-person visit, such as specific body language demonstrated by the patient. Although, some interviewees acknowledged that they may not have used telehealth enough to be efficient with the technology being used.
Overall, the interviews revealed that the respondents were using telehealth and the technology could be used to improve care through better operational support and coordination. While the interviewees noted that telehealth was likely here to stay, they also expressed the need for more policy and regulatory support, and highlighted the importance of sustainability. The top messages identified for regulators and policymakers cited in the report were:
- Reimbursement: Allow permanent reimbursement for telehealth relative to in-person care; offer the same equitable reimbursement for telephone health encounters. Improve consistency with enhanced rates received by RHCs and FQHCs for face-to-face visits.
- Basic technology: Increase connectivity to the Internet and cellular service to allow all patients who are willing the opportunity to connect with their providers via telehealth, especially those in rural locations.
- Policy guidance: Provide clear and consistent guidance on how and under what circumstances telehealth can be used in safety net health care organizations. With permanent reimbursement for telehealth (see above item), provide clarity and support for translating the rules among providers and administrators to build confidence in the use of telehealth services.
- Innovation: Provide funding and support for innovative ways to improve access, such as those demonstrated by experiments with mobile clinics, digital technology is schools, school- or home-monitoring devices (such as blood pressure or blood sugar monitors and cameras), and coordination with mini-clinics for patients to go to at their convenience (e.g., a commercial urgent center for labs at 7pm coordinated by telehealth).
The researchers acknowledged that the sample size of this study was quite small and that future research should continue to explore how telehealth works, and even more specifically, how it works for an FQHC/RHC. Future studies can help refine policies that would enable these organizations to more effectively and efficiently utilize telehealth to treat their communities. The full study can be found on the RTRC website. The study was supported by the Office for the Advancement of Telehealth.
See original resource at : https://www.cchpca.org/
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