Sunday, February 10, 2013

Spotlight on Rural Issues

Over 400 conference participants from rural areas throughout the country gathered in Washington D.C. February 4-6 to attend the National Rural Health Association’s 24th annual Rural Health Policy Institute. The attendees participated in discussions on NRHA’s 2013 Legislative and Regulatory Agenda and listened to ideas on how to effectively promote actions for rural communities that will be accepted by Congress, federal regulatory agencies, the White House, states, and the healthcare industry.

Speaking at the General Session, Doug McKalip, White House Domestic Policy Council Senior Policy Advisor for Rural Affairs, recounted how he grew up in Northwest Pennsylvania in a rural community and he knows first-hand the gaps in finding healthcare in the community. One of the most serious problems to obtaining care is the lack of broadband coverage and even where the internet exists; there are too many gaps in transmission.

To work with the White House on rural issues, NRHA in 2012 participated with HRSA’s Office of Rural Health Policy and the White House Rural Council to discuss a number of initiatives including the future of primary care, the expansion of the National Health Service Corps eligibility, and how to achieve coordination between various rural health providers.

At the NRHA Institute, telehealth was on the agenda. Mary Wakefield PhD, RN, HRSA Administrator recalled how HRSA in 2012 funded an Institute of Medicine (IOM) meeting with telehealth leaders to discuss all of the recent telehealth accomplishments and future goals. The report is available on the IOM website at

Dr. Wakefield discussed two telehealth grant program announcements that were released in December 2012. One grant program the “Telehealth Network Grant Program with the closing date of February 13, 2013 will fund projects that demonstrate the use of telehealth networks to improve healthcare services for medically underserved populations in urban, rural, and frontier communities.

The other grant program the “Telehealth Resource Center Grant Program” supports the establishment, development, and strengthening of Telehealth Resource Centers. The response is due February 25, 2013.

NRHA’s 2013 legislative and regulatory document includes specific ideas on what the Administration and Congress needs to do in rural communities as it relates to telehealth such as:

  • Reimbursement for services provided through telehealth should be made based upon medical effectiveness and utilization and not based on particular delivery platforms or locations
  • Medicare law should be expanded to allow anything currently covered by Medicare to be reimbursed when provided by telehealth
  • A telemedicine payment methodology should be provided for conventionally delivered services
  • The Regional and National Telehealth Resource funded by the Office for the Advancement of Telehealth within HRSA should be expanded
  • The federal government should adopt a policy to allow telemedicine providers to receive deemed status and allow healthcare facilities receiving telehealth services to perform credentialing by proxy or delegated credentialing
  • Geographical patient requirements for receiving care in a HPSA and non Metropolitan Statistical Areas should be lifted
  • Separate billing procedures for telemedicine should be eliminated
  • Care provided by a physical therapist, respiratory therapist, occupational therapist, speech therapist, and social worker should be reimbursed
  • A fair market reimbursement system for originating telehealth sites should be implemented
  • Reimbursement for store-and-forward applications should be provided.
  • EMTALA regulations should be changed to allow a telehealth physician to meet the physician requirements for emergency care   
 NRHA would like to see a number of other changes related to health IT:

  • A redesign of the present telecom subsidy models and universal access polices to enable all citizens to have access to an affordable and appropriately configured broadband system
  • The development of integrative partnerships with informatics resources to support adoption of EHR technology
  • Medicare EHR incentive payments should also be available for facilities to participate in electronic Health Information Exchanges
  • Support of emergency medical services to be coordinated and supported by federal agencies through policy development, data systems appropriate curricula, and access to grants
  • Emergency preparedness must have information systems to meet the needs of local rural communities
  • Congress should require vendors of IT systems used in rural communities to incorporate national standards for health IT into their systems and Federal and state governments should enable the infrastructure and policy framework so more networks can be formed
  • More funding for rural hospitals and eligible professionals to purchase and support health IT
  • Funding should be provided through a combination of grants, loan guarantees, and/or principal and interest forgivable loans to support health IT
 For more information, go to