The telehealth paradox—and where the ‘revolution’ must go from here
Telehealth had a moment during the COVID-19 crisis when HHS took steps—some temporary, others permanent—to expedite adoption and promote awareness.
Now three business scholars show the resulting “telehealth revolution” can paradoxically work against its implied promise to broaden care access.
In a study published in the journal Information Systems Research and explained for lay readers in the online magazine Slate, the academics find urban physicians leeching patients from rural areas.
The effect may be inadvertent or sly. Either way, it can just as easily hurt as help the patients themselves.
As the business researchers point out, gaining access to practitioners affiliated with medical schools often means availing oneself of care informed by the latest scientific research and medical education.
However, it also can mean losing touch with local clinicians who may be best positioned for face-to-face care once virtual visits run their course.
What’s more, in the latter scenario, the patient siphoning can add financial pressure to already-strapped community providers.
Should these providers fail as a result, in-person patients will be left scrambling for care.
Potentially dire consequences
The authors of the study and article are Gordon Burtch and Meizi Zhou of Boston University’s Questrom School of Business and Xuelin Li of the Columbia Business School in New York.
They report that urban hospitals and physicians gain an average of 2.6% and 1.9% in revenues and payments after a state joins the Interstate Medical Licensure Compact. This is the regulatory mechanism, now in place in 30-plus states, that paves the way for providers to easily obtain medical licensure across state lines.
That’s the upside. The downside? The same framework causes rural hospitals and providers to lose an average of 4.6% in revenues and 5.6% in payments.
“The added strain posed by telehealth could have dire consequences for many forms of rural health care access, including those for which telehealth is no substitute, like emergency medical care,” the business professors write.
They cite a 2020 report by the U.S. Government Accountability Office showing closures of rural hospitals markedly cut rural patients’ access to care.
Room for everyone
Rural hospitals “play a vital role in supporting the local economy and social fabric of their communities,” Burtch and colleagues write in Slate.
They quote a report from the American Hospital Association showing that, in 2020 alone, rural hospitals contributed $220 billion in economic activity and supported 1 of every 12 rural jobs.
To create a path to optimal patient access and rural provider viability, the authors call for closer cooperation between and among policymakers, healthcare providers, insurers and patient advocates.
The win/win, they suggest, will be leveraging telehealth technologies such that rural patients have sustainable access to rural as well as urban providers—and vice versa.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.