Shaun Robinson
Boston University Statehouse Program
Published 4:40 a.m. ET Mar. 18, 2021″
BOSTON – Outer Cape Health Services runs three clinics in one of the state’s most rural coastal areas, but for much of the past year, many of their patients have sought care from home. Some are measuring their blood sugar levels on a clinic-provided monitor; others are phoning in for behavioral medicine.
The organization, which has locations in Provincetown, Wellfleet and Harwich Port, took a financial hit and furloughed staff last spring as the number of in-person visits fell, said Pat Nadle, Outer Cape Health Services CEO. Still, Nadle said, remote care is going to stick around as patients come back in. The technology may even help doctors serve them better.
Remote care may help doctors serve patients better
In rural Massachusetts communities from Nantucket to Berkshire County, local health care providers are playing a critical role in the state’s fight against COVID-19. Yet, many of these facilities, which already were operating on thin profit margins and with small staffs, have faced outsized challenges as patients canceled elective procedures and doctors took on additional responsibilities.
Now, as vaccines are rolling out statewide and a new, post-pandemic normal is in sight, advocates say rural health care centers need strong support from local residents and lawmakers. In addition, advocates say, expanding access to telehealth, which lets doctors reach patients safely in underserved areas, is critical.
“They’re not just providing quality health care, but they’re also an economic driver in the community,” Ann Marie Day, executive director of the New England Rural Health Association, said of programs such as Outer Cape Health Services. “They provide a lot of jobs and bring a lot of folks to the community to work, so it’s really important to be able to invest in those rural safety-net providers.”
Statewide, hospital profit margins fell about 4.5% by the end of June 2020, compared with the same time a year earlier, according to the most recent data from the Center for Health Information and Analysis. Less than half of hospitals were in the black, the center found, and the median total margin was -0.7%.
Community hospitals, which serve many of the state’s most vulnerable communities, were among the hardest hit, the data shows. They reported a roughly 7.5% drop in profit margins, and a median total margin of -4.8%. Without government support, the report states, facilities would have gone deeper into the red.
Hospitals in Massachusetts received about $1 billion in federal funding and about $160 million in state funding through the end of last June, according to the report.
President Joe Biden’s approved COVID-19 relief plan includes $8.5 billion of funding for rural hospitals and health care centers to cover expenses and lost revenue as a result of the pandemic. The plan also will provide $500 million for Department of Agriculture grants to rural providers.
“Support from the state and federal government has helped our community hospitals survive this crisis,” Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association, said in a statement. “We remain in close contact with our elected officials to ensure these providers have the resources they need moving forward.”
Providers also have benefited from a state law signed in January requiring insurance companies to provide equal coverage for telehealth and in-person visits, or what is known as coverage parity.
Telehealth lets doctors safely reach patients in underserved areas
Andrew Solomon, senior program manager for Northeast Telehealth Resource Center, said while remote care has helped rural hospitals reach patients for decades, the need for social distancing, as well as legislation like the commonwealth’s parity law, have made the technology more ubiquitous and accessible.
For patients who have a disability or live in areas with limited transportation options, Solomon said, telehealth is a vital tool that enables access to care. Patients who live in small communities may not want to be seen receiving treatment and so prefer the privacy of telehealth, he said, and in some cases, a virtual emergency room visit can provide more timely care than an in-person visit would.
“Providers who hadn’t adopted telehealth before are seeing benefits like reduced no-shows, and those kinds of things are big drivers for providers,” Solomon said. As demand increases and “consumers get more familiar with the potential benefits,” he added, “there will continue to be big drivers there.”
Day, of the New England Rural Health Association, said one challenge for rural telehealth care continues to be limited broadband internet and cellphone connectivity. This is why it’s important that insurance covers telephonic visits, she said, since all that some households may have is a landline.
In 2016, the state identified more than 40 towns in western and north central Massachusetts lacking residential access to broadband. Towns can apply for state grants to build municipally owned networks.
What is telehealth?
“Telehealth is a very broad term,” Solomon said. “There’s a lot of applications and use cases within that, that range from the on-demand live video to remote patient monitoring to provider education opportunities.”
Solomon said telemedicine also allows for joint consultations between primary care providers and specialists, which can help save patients’ time. For instance, he said, a primary care doctor could take a picture on an iPad and send it through a secure platform to a dermatologist; the latter could then decide whether the patient could be treated where they were or whether they required more advanced care.
“Specialists don’t drive out to the Outer Cape much,” said Nadle, of Outer Cape Health Services. “To be able to ‘Zoom’ into a specialist in the treatment room, while you’re in there with your primary care provider, is certainly an option right now to help coordinate care in a much different way.”
Day said rural medical providers also are important vehicles for getting COVID-19 vaccines out to isolated and vulnerable people in their communities. Outer Cape Health Services is distributing about 600 to 800 shots per week across each of its clinics, Nadle said.
In addition to the vaccine rollout, Nadle said, the organization is expanding support for victims of substance abuse who may have been especially struggling with the stressors of the pandemic. Behavioral health care has worked well as a remote service, she said.
At Athol Hospital in northern Worcester County, one takeaway from the pandemic has been the importance of staff collaboration, said Dawn Casavant, vice president of external affairs for the hospital’s parent organization, Heywood Healthcare. Senior leadership and managers have started holding daily meetings to share updates from across the hospital’s departments, she said.
Athol Hospital is a critical-access hospital, a federal designation given to some rural hospitals in remote areas.
“The intersection of all of the primary areas that allow a hospital to function was exaggerated by 1,000% when you’re in a pandemic,” Casavant said. “It’s proven to be really worthy and beneficial for the system to have that opportunity every single morning to start the day on the same page.”
