Why rural hospitals need a telehealth roadmap

In an attempt to support rural hospitals amid the funding cuts approved through the OBBA, Congress created the Rural Health Transformation Program, a five-year initiative that will inject $50 billion into states to support rural health facilities. The funds, though unlikely to fully offset the OBBA cuts, are intended for certain approved use cases, including health technology implementation.

This has created a new pathway for virtual care investment among rural hospitals, as well as a need for guidance as they consider how to incorporate these technologies into their clinical, financial and operational strategies.

Kruis noted that with the launch of the RHTP, the time felt ripe for a playbook to guide rural hospitals in their telehealth partnership journey. Manatt conducted background research on the rural hospital landscape, landing on MUSC as an example of how telehealth can offer a lifeline to rural hospitals.

Over the past 15 years, MUSC has developed numerous hospital-based telehealth services, including telestroke, tele-ICU, virtual nursing, telehospitalist, virtual palliative care, telepsychiatry and telebehavioral health, Emily Warr, administrator of the Center for Telehealth at MUSC, shared.

"We've got lots of experience working with different hospitals of different sizes and levels of rurality in the state of South Carolina over the years," she said.

To develop the playbook, Manatt and MUSC identified key strategies and best practices from the health system's partnerships with more than 40 hospitals across South Carolina. They also interviewed rural hospital CEOs to understand their unique needs, challenges and perceptions of telehealth partnership.

Step-by-step advice to advance telehealth use 

The playbook details a telehealth partnership maturity model, which is a framework to help rural hospitals assess the maturity of their telehealth and move toward more strategic and integrated telehealth utilization.

The maturity model includes three tiers: early, operational and transformational. Hospitals in the 'early' tier implement telehealth in a siloed, fragmented or pilot-based manner; those in the 'operational' tier have a more standardized, integrated and scalable approach to telehealth implementation; and those in the 'transformational' tier have implemented telehealth as a core modality for care delivery and institutional sustainability.

"There's value in each one of those levels of maturity," Warr said. "It just sort of depends on where a hospital is in their ability to integrate technology and workforce that's not local into their general operations."

Kruis added that the playbook also provides rural hospital leaders with different domains where they can make changes to move toward the 'transformational' tier of the telehealth partnership maturity model.

For instance, one domain is a hospital's strategic approach to telehealth partnerships. Hospitals can assess their maturity in this domain by evaluating factors, such as whether they use telehealth to address immediate service gaps or whether their telehealth services are strategically aligned with long-term community needs and organizational priorities.

The playbook also includes concrete steps hospitals can take within each domain to advance from one maturity level to another, Kruis noted. To advance their maturity in their approach to telehealth partnerships, hospital leaders can use data to identify service lines that would benefit most from telehealth implementation.   

Another key domain is staffing and change management. To advance from the 'early' to the 'transformational' maturity tier within this domain, the playbook recommends creating a multidisciplinary, hybrid telehealth staffing model and developing role-specific training.

"The different domains are really important because oftentimes, folks jump to equate sort of telehealth service with technology implementation, period, like, as simple as that," Warr said. "There's just so much more. There's a richness to implementation here, and it starts with that strategic approach. You have to have a strategy; you have to have a problem that you're solving."

Ultimately, Warr and Kruis hope the playbook will provide rural hospitals with actionable steps to move from a siloed telehealth approach to a more transformational one.

"Telehealth partnerships are improving access, improving workforce stability, improving financial performance, key metrics that hospitals care about, like length of stay, like their case mix index," Kruis said.

And while it may seem daunting to get started, Warr encouraged rural hospitals to start incorporating telehealth into their care delivery model in some way, using the playbook to slowly advance to the most mature version of telehealth integration.  

"Take that first step and work to integrate some level of virtual care [into your organization] to solve the difficult challenges that a rural hospital faces on a regular basis," she said.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.