Between 2005 and the present, 195 rural hospitals have closed, with a 50-hospital net reduction occurring just between 2017 and 2023. These closures, compounded by significantly worse measures of social determinants of health (SDOH), high prevalence of Medicaid or Medicare patients, and longer commute times, have created a crisis of access for rural Americans.

The disproportionate impact on rural residents

Compared to their urban and suburban counterparts, rural residents face disproportionately high rates of diabetes, mental/physical distress, and premature mortality, with life expectancy gaps widening. Coupled with federal Medicaid funding slated to be cut by $1 trillion over the next 10 years, and almost 25 percent of rural individuals under the age of 65 being covered by Medicaid (with 22 percent of these individuals being dual-enrolled in Medicaid and Medicare), this can be a humanitarian crisis for our rural populations.

When viewed holistically, rural patients face longer drives, fewer providers, and worse outcomes. They need more than clinical care and temporary fixes; they need policy-level support and a health care system that supports them.

Telemedicine as a lifeline

When faced with this discrepancy, one potential solution is increasing the prevalence of telemedicine. As shown during the COVID-19 pandemic, telemedicine can connect millions of Americans with health care providers, especially when they are unable to meet in person. Telemedicine could help eliminate many of the problems that rural patients face, such as distance to clinics or lack of specialty care services. It could revolutionize longitudinal care for patients with chronic diseases or those with increased risks associated with in-person visits, such as the immunocompromised, through regular monitoring and follow-up care.

Through my work in an allergy clinic, I have personally seen the benefit of telemedicine for patients who are unable to attend in-person visits, given their life-threatening immune deficiencies or reactions; these patients are a relative minority, and yet the benefit was widespread and revitalizing for this population. For a much larger population, such as those with diabetes, telemedicine could provide much-needed assistance, especially given the higher prevalence of diabetes within rural communities.

Remote medical care has been shown to show significant improvements in patients’ health outcomes and cost savings, especially regarding clinical findings such as HbA1c or diabetic-related food disease, regardless of geographical barriers.

Barriers to adoption

While telemedicine could potentially solve many of the problems involved with rural medicine, there are issues, such as many individuals within these regions facing unequal and arbitrary health care policies or having limited access to broadband internet. Compounded with the challenges related to digital literacy, and a lack of a uniform national telemedicine policy, widespread usage of telemedicine may be difficult to adopt.

One consequence of the lack of uniform telemedicine policy is the varying insurance coverage and reimbursement, both between states and between private and governmental insurance. While live video reimbursement through Medicaid is covered across the states, only 34 states cover store-and-forward reimbursement, of which seven have additional restrictions on reimbursement; remote patient monitoring and audio-only visits also have disparities per state.

For private insurance, there are currently only 21 states that mandate payment parity between telehealth and in-person visits. While issues with broadband access is a separate battle, there is viable headway to be made regarding insurance and national policy, and it should be the first step to be made in our regulatory debates.

The path forward

To make telemedicine a lasting and equitable part of our health care system, instead of just a pandemic-era stopgap, we need bold, coordinated action on two fronts. The steps required to change the paradigm of telemedicine within the U.S., in this post-pandemic health care system, involve increased support from the medical providers themselves and better policy support for telemedicine.

• Provider support: Increased support from within the system will require providers to keep an open mind towards telemedicine. While it is a large shift from the type of medicine many providers are used to, especially those who have been in the field for many years, there is enough evidence to support the benefits of telemedicine for many populations of patients, with emphasis on those with chronic diseases or lack of provider access. By offering staff telemedicine training and establishing proper facilities, medical centers can enhance their ability to deliver patient care through telemedicine services.
• Government support: Beyond the providers themselves, government support is crucial for the greater adoption of telemedicine, requiring greater telemedicine coverage and payment parity across states and across the private-government insurance divide.

As it currently stands, policy restricts the ability of providers to offer the most inclusive care to our diverse patient population. As a population, providers should push for and support insurance reform and regulation to better prepare for the needs of patients, no matter their background.

Griffin Popp is a medical student.