One of the few things the federal government has done right during the pandemic has been to loosen regulations on expanding telehealth. As those barriers have fallen away, the benefits of telehealth, especially for mental health, have become apparent. Appalachian states, from North Carolina to Ohio, have also made getting health care to the people who need it easier than before COVID-19.
In the future, state and federal officials should take note of how this episode of de-regulation has helped some of the most at-risk groups of Americans, rural or otherwise. Making it easier for doctors, therapists, and hospitals to use phone calls and video calls for treatment has been vital.
A recent study in the Journal of Rural Health, published by the National Rural Health Association, noted how important video telehealth has been for mental health. Jan A. Lindsay, Julianna B. Hogan, and their co-authors described how remote health care has helped rural residents seeking mental health care during COVID-19.
While a phone call is easier for billing reasons or to stay HIPAA-compliant, many patients get more benefits from a video call. It “provides a more personal experience” and enhances interaction with the therapist, Lindsay notes. A face-to-face connection matters.
“Investing effort to adapt and become skilled in [video-to-home] delivery will allow us to continue to overcome barriers that prevent individuals in rural areas from receiving [mental health] treatment and improve the effectiveness of the care we deliver,” Lindsay et al write.
Problems remain of course, such as issues with internet access or insurance plans covering telehealth, but Lindsay et al expect demand for video telehealth to rise and push doctors to offer it—so long as insurance plans cover it. COVID-19 might be the push necessary to do so. For example, in March, the U.S. Department of Health and Human Services waived potential penalties for HIPAA violations so health care providers could provide remote care over apps such as Skype or WhatsApp. The goal was to encourage providers to treat at-risk patients without potentially exposing them to COVID-19.
The waiver also meant government-funded health plans would cover telehealth services. Getting the federal government to make that move matters because it’s a major payer. In 2019, the federal government spent $1.2 trillion on health care, which includes $644 billion for Medicare and another $427 billion for Medicaid and CHIP.
The rapid switch to telehealth has caused some problems; the infrastructure for it wasn’t always prepared. Health care providers didn’t always have the right technology, and a lack of reliable internet service also presented problems. One goal for local leaders and state or federal representatives should be to remove legal barriers to expanding telehealth, both during the COVID-19 pandemic and afterward. Another is to make it easier for health care providers to take charge and fix their own problems. With a more flexible health system, providers can treat mental health issues earlier before people reach a crisis.
It’s no surprise that Lindsay et al’s study on mental telehealth received funding from the Veteran’s Administration: Veterans are at higher risk of suicide than the general population. Rural areas and small towns also have higher suicide rates; learning from pandemic de-regulation and using telehealth effectively could have a large, positive effect for these parts. The lack of mental health treatment in rural areas means that telehealth can connect residents to services they couldn’t use before. Some states have taken action that others should pay attention to.
For de-regulation, Texas has been a bright spot. In March, the state set up a mental health hotline for free support and resources to Texans in need of them. Then, in April, Governor Greg Abbott, like the U.S. Department of Health and Human Services, waived restrictions on telehealth. Following the changes, scheduled appointments spiked. In the Midwest, Iowa State University created Iowa Concern, a portal to help farmers get legal advice, financial counseling, and mental health resources.
Appalachian states could do better than they are. Though Pennsylvania waived some licensing requirements early on, a bill to expand telehealth passed the Senate but was vetoed by Governor Tom Wolf because it wouldn’t apply to getting a prescription for an early-term abortion medication. North Carolina has also had trouble expanding telehealth in some parts because patients didn’t have access to broadband internet. As some legal hurdles to telehealth disappear temporarily, other political and practical barriers still slow its use.
States will have to figure out what challenges they have and what it will take to fix them.
Luckily, with health providers gaining the ability to solve their own problems as state and federal laws loosen, they can try new things. In Colorado, telehealth has made it possible to dispatch a half-dozen RVs across the state to help opioid users access medication-assisted therapy, counseling, and medical treatment that they wouldn’t have otherwise. Southwestern Virginia has a similar initiative.
As the effects of de-regulation or suspending unnecessary health laws are shown, states should consider making them permanent, rather than thinking of the change as temporary.
Even before COVID-19, hundreds of rural hospitals across America were at risk or financially unstable due to falling revenues and local populations. Since the pandemic hit, some experts worry that the sky is falling. Government tax revenues and state budgets will drop, as will private donations. Making it easier for doctors and nurses to treat patients, and maintain patient flows, will be paramount. Otherwise, the worst off are liable to suffer even more, and some hospitals and doctor’s offices will go out of business.
Rural people already deal with a shortage of doctors, and the doctors they do have tend to have less experience or are less specialized, which may make their health outcomes worse. Telehealth isn’t a magic pill to cure what ails rural health care, but it has an important part to play in making people’s lives better.
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Anthony Hennen is managing editor of expatalachians and managing editor of the James G. Martin Center for Academic Renewal in Raleigh, North Carolina.
