Many federal programs, including telehealth initiatives, make a significant difference in rural healthcare and should be continued, rural hospital representatives testified during a recent Senate Appropriations subcommittee hearing.

Government-funded telehealth programs, for instance, are improving outcomes while lowering costs, Kristi Henderson, chief telehealth and innovation officer at the University of Mississippi Medical Center told the subcommittee on labor, health and human services and education.

Also See: Success of Telehealth Seen Tied to Medicare Reimbursement

For instance, the UMMC Center for Telehealth connects 15 rural hospital emergency departments with the university’s Level One trauma center, enabling real-time consultations with emergency physician and their patients. The program has cut ER staffing costs by 25 percent, reduced unnecessary transfers by 20 percent “and has produced patient outcomes in rural hospitals that are on par with that of our academic medical center,” Henderson said.

The telehealth program, supported by $9.7 million in federal grants and also funded by state and private grants, also serves other provider sites, covering 35 medical specialties in 165 sites across the state and serving an average of 8,000 patients each month. “Today, I am pleased to report that our system is completely self-sustaining,” Henderson told lawmakers. “Without early, critical support from FDA, HRSA, FCC and others, however, our network would have been very slow to deploy, if ever, taking the longest to reach those with the most need.”

Mississippi’s state government removed barriers and enabled expansion of telemedicine services, she added.  Legislation enacted in 2013 mandates that public and private insurers reimburse for telehealth services at the same rates as in-person services. More legislation signed in 2014 requires equal reimbursement for remote patient monitoring services using store-and-forward telemedicine technology.

Still, other barriers remain. The Centers for Medicare and Medicaid Services continues to restrict telehealth reimbursement to patients being treated in a Rural Health Professional Shortage Area or in a county that is not considered part of a Metropolitan Statistical Area, Henderson explained. “Many urban areas also are medically underserved and would benefit greatly from access to telehealth. I would request that CMS consider removing geographic restrictions for telehealth reimbursement.”

Reimbursement parity for telehealth services works at the state level, and it is time to bring parity to the federal level, Henderson told senators. “The only way to know if success at the state level can be replicated at the federal level is to test it. Now is the time for CMS to pilot reimbursement parity models for these technologies, especially in-home monitoring, where impact is greatest.”

View from Washington State

Julie Peterson, CEO at PMH Medical Center, a 25-bed critical access hospital in Prosser, Wash., praised Washington State’s expansion of Medicaid and implementation of a health insurance exchange under the Affordable Care Act.

Both moves dramatically reduced the number of uninsured residents, she said.  By April, 170,000 individuals had bought coverage from the exchange, with nearly 80 percent receiving a subsidy to help pay the premium.

Peterson also applauded federal grant programs that have resulted in improved care quality while cutting costs, along with grants to expand data analytics, measure performance and enhance information systems interoperability. For instance, an $876,000 grant from the Federal Office of Rural Health Policy will help a network of 12 critical access hospitals and 20 rural health clinics enhance their information technologies. The network “also will work to develop a shared health information technology infrastructure link to a common dataset to reduce chronic disease,” she said.

Testimony from all witnesses at the hearing is available here.

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