A technician works on a line used to provide broadband internet service in a rural are in Stowe, Vermont. (AP Photo/Wilson Ring)

From exchanging vital resources, like ventilators, to launching mobile vaccine delivery, rural healthcare innovations have been plentiful during the pandemic.

“I do think necessity has been the mother of invention,” said Tom Morris, associate administrator for Rural Health Policy in the Health Resources and Services Administration (HRSA). One of the clearest examples is the boom in telehealth. “It clearly has played a role in keeping services available…and maybe even expanded availability of care to places in rural America that even before the pandemic were not as well served,” said Keith Mueller, a national expert on rural healthcare issues at the University of Iowa.

Enabled by waivers put in place by the federal government, telehealth has seen spikes in utilization in both rural and urban areas during the Covid-19 pandemic. As people have returned to their physicians’ offices, there has been a decline, but not to pre-pandemic level. “That, to me, is evidence of the utility of telehealth to meet access needs,” Mueller said. 

“Policy-makers are going to have to figure out what continues,” Morris said. While that may not be entirely clear yet, he believes one thing: “People like having this option.”

Unfortunately, a key component is still missing for many rural communities. “It doesn’t do us much good if people don’t have broadband access to take advantage of it,” Morris said. Leveraging existing broadband programs through the USDA and Federal Communications Commission could remove some barriers. 

Another hurdle that has been amplified during the pandemic is a shortage of providers. Part of the solution comes from opening the scope of practice and services offered. “What can we do to help the population without bringing them into a clinic and without even rising to the level of a clinical provider?” Mueller asked.

Important resources, such as health coaches and care managers, can play an integral role in the care continuum. “One of the things we’ve seen about managing through a surge is the capability of providers to collaborate,” Mueller said. Though this idea was percolating prior to the coronavirus, Mueller said, “where there have been surges, there has been greater realization.” 

Collaboration can reduce some of the burdens, but in rural areas especially, there is a simultaneous need for more providers. Toward that end, Morris said, “We’ve seen steady growth in the programs offered by our bureau.” A promising initiative is the Rural Residency Planning and Development Program (RRPD), which supports the creation of new rural residency programs in family and internal medicine, as well as psychiatry. 

The program’s $32 million in funding can be used for planning and development costs while achieving accreditation through the Accreditation Council on Graduate Medical Education (ACGME), as well as tracking residents’ career outcomes and retention post-graduation.

So far, 13 award recipients have received program accreditation, and six programs matriculated more than 30 residents during the latter half of 2020, ahead of RRPD program milestones. As the residents prepare to help meet healthcare needs in rural areas, healthcare leaders are also reimagining the entire structure of their delivery models. 

Mueller said with the federal financial support provided to rural hospitals over the last year, “We should come out the other end of the pandemic in a similar posture to what we were going into the pandemic, which is not good for a lot of rural areas.”

“The challenges facing rural hospitals and particularly the closure of rural hospitals—we’ve been tracking that since 2010,” Morris said. 

In response, a new model called the Rural Emergency Hospital (REH), has been introduced and is timely. 

As part of relief legislation approved at the end of last year, Congress established (REHs) as a new Medicare provider type effective January 1, 2023. This incorporates providers who offer specific outpatient services in rural areas, including emergency department services. 

“That’s a very different way of looking at what has traditionally been defined as a hospital in rural areas,” Morris said. Mueller said stakeholders have been gradually exploring how and where to best serve community members outside the walls of hospitals and clinics. 

This will be essential in rural areas, where, according to Morris, challenges have “really just been exacerbated by the pandemic.” He described widening gaps of disparity, which become “even more challenging when you go down by ethnicity.” In his mind the best way forward is community by community. “We can help lift up those efforts,” he said. 

While much will rely on public policy, Mueller said, “The local actors have to be doing things too.” According to Mueller, we overlook the bottom up too often. “That becomes the challenge, but it’s one that we have to meet because the longevity and sustainability of these changes happens locally.” 

Caroline Tremblay is a freelance writer and assists in the news coverage of Radically Rural, a two-day summit on key rural issues, September 22-23, in Keene, New Hampshire.