Rural Telemedicine Growing More Slowly than Expected

Telemedicine has been touted as a revolutionary solution to the shortage of physicians in rural areas, but a recent study published in JAMA suggests that although this trend may have begun, it has not yet snowballed as expected. Between 2005 and 2017, 83.3% of patients with commercial insurance who used telemedicine services lived in urban areas. This suggests that they were not driven to use telemedicine by a shortage of physicians, but rather by other factors such as convenience. Such a surprising result seems contrary to the belief that rural patients are seeking greater access to physicians; if this were the case, then one might expect more rural telemedicine than urban telemedicine.

The scarcity of physicians in rural areas, where one in five Americans lives, has long been a concern; the onerous travel requirements of taking time off work to drive one or two hours to visit the nearest specialist, or of asking a driver to do so, make it difficult for many rural Americans to access such doctors. Some patients cannot even leave their homes easily due to medical or physical limitations; for them, traveling to the doctor’s office becomes a burden. Proponents of telemedicine have promoted the technology as a way for doctors to conduct follow-up visits and check-ups with the patients from the comfort of the patient’s own home, thus eliminating the travel requirements.

In addition, telemedicine advocates cite cost savings associated with adoption of the technology. According to a 2017 report from the Rural Broadband Association, telemedicine services were associated with an average annual cost savings of $20,841 per US hospital. Some estimates, including remote patient monitoring, predict a cut of $4.3 billion off the nation’s yearly healthcare bill.

With such significant advantages, why isn’t telemedicine being used more heavily in rural regions? Several factors could be contributing to this phenomenon:

• Lack of parity legislation – Only 34 states and the District of Columbia have adopted parity laws requiring payers to reimburse telemedicine visits at rates comparable to those of in-person visits. Without parity laws in place, payers are not forced to acknowledge or cover telemedicine visits. We need to encourage our lawmakers to recognize telemedicine services as a legitimate form of medical services.
• Lack of knowledge – Some patients may not be aware that telemedicine is an option offered by their insurance plans, or they may not fully understand the tight security and privacy offered by rural telemedicine. Perhaps they simply need to be educated about the availability and safety of telemedicine services.
• Lack of infrastructure – Many rural areas lack the high-speed internet connection that is required to maintain a broadband connection, which most telemedicine platforms require for operation. The exception is swyMed; our system can provide real-time high-definition virtual care ranging from low-bandwidth environments to 5G networks.
• Lack of technology – Whether a patient remains at home or visits a local clinic to access the telemedicine tools with which to contact the urban physician, he/she needs the right digital equipment. Some medical clinics may not have the proper tools yet; perhaps they can partner with an urban healthcare system that can provide the needed tools at a discount. At home, the situation becomes more complicated because many devices have not yet been approved for consumer use. Over time, as more devices meet FDA approval for in-home use, more patients should have access to the technology required for in-home telemedicine services.

Despite the rapid growth of telemedicine usage among consumers, the industry is still in its infancy; among the commercially insured, only 202,300 telemedicine visits occurred in 2017. Considering that the vast majority of these occurred in urban environments, hardly any visits were made by rural patients. Hopefully, as we overcome the factors listed above, rural consumers can enjoy the benefits of telemedicine too.

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