Rural hospitals need telehealth most but often don't have it

Rural hospitals are the most likely to benefit from telemedicine, especially for emergency patients, but they're the least likely to have it because of government reimbursement barriers and low patient volume, according to a study report in the Journal of the American Medical Association.

The researchers used telestroke care as a case study. Stroke patients must receive treatment very quickly, and often there is not enough time to transfer them to a larger hospital that has stroke specialists. Through telestroke, small, rural hospitals can initiate care for such patients, but they are less likely to have telehealth than larger, suburban hospitals, and the inequity may contribute to worse conditions and more deaths among rural patients.

The cost of implementing telehealth is a significant barrier for rural hospitals; it can cost from $17,000 to $50,000. Plus, hospitals must pay an average of $60,000 for annual subscription fees, and $3,000 to $8,000 per year in maintenance and connectivity expenses. And many such hospitals don't get enough patients who need telehealth to cover the costs of the service. And dealing with the reimbursements—which are often insufficient—is a bureaucratic headache many hospitals would rather avoid. 

The researchers suggest some changes that could help increase telehealth adoption in rural emergency departments. For instance, EDs pay for telemedicine, but the reimbursement typically goes to the remote specialist who treats the patient via telehealth. EDs can bill consultants for the hospital's telehealth subscription expenses, but it's such a cumbersome process that most EDs just eat the cost and write it off as overhead. Instead, the paper suggests, payers could reimburse the hospital directly for telehealth-related costs.