- Inadequate IT infrastructure is a significant barrier to telehealth adoption for safety-net providers, those who offer care access to underserved and disadvantaged populations, according to a new report from RAND.
RAND interviewed representatives of seven state Medicaid programs and 19 urban and rural federally qualified health centers (FQHCs) who said that poor broadband connectivity is a telehealth obstacle.
One representative from a Western rural FQHC said that she offers telehealth services at the center’s main site, but not at satellite sites, because of insufficient broadband capacity in frontier communities.
She said that inadequate broadband connectivity prevented her from offering remote patient monitoring (RPM) to patients who lived outside of the three towns the center serves.
A representative from an urban FQHC running a telehealth program for a homeless population also complained about insufficient connectivity.
Equipment costs were identified as another barrier to telehealth adoption. One representative from a rural FQHC in the Northeast said that the cost of equipment deterred the center from implementing telehealth.
“It was going to be $50,000 just to get the equipment and set up the portal. Neither organization [originating and distant site] could see covering those costs after we covered our providers’ cost. It would just be a foolish proposition administratively, because neither one could afford to throw that kind of money into it,” the representative told RAND.
Other FQHC representatives complained about equipment failures that required staff time. One interviewee from an urban FQHC in the South said having only one IT specialist who “doesn’t have a whole lot of time to work on troubleshooting” made it difficult to fix technical telehealth problems.
Inconsistency regarding telehealth policies at state Medicaid programs was a major concern of interviewees. They complained that there was a general lack of clarity about which telehealth services were allowed by the Medicaid program, ambiguity around telepresenter requirements, lack of authorization for FQHCs to serve as distant sites in the federal Medicare program and some state Medicaid programs, and insufficient reimbursement for telehealth services.
RAND identified other barriers to telehealth services faced by safety-net providers, including telehealth as a cost center, billing challenges, lack of buy-in among providers, challenges to specific patient populations, complexities in adjusting clinic workflow, inadequate supply of telehealth specialists, complex logistics around credentialing and licensing, and challenges in working with remote providers.
The report offered several telehealth recommendations for policymakers, payers, and FQHCs:
- Authorizing FQHCs to serve as both originating and distant sites could spur the growth of telehealth in the safety net
- FQHCs and their partners would benefit from clarification of telehealth policies, especially as they affect FQHCs
- Telehealth may be most effective if implemented as part of a suite of strategies to address workforce shortages in rural areas
- Case studies of successful telehealth programs would be beneficial for FQHCs
- Telehealth program duration needs to addressed in telehealth policies and practices because services can be implemented as a short-term or long-term solution
- Future research should inventory telehealth policies specific to FQHCs and examine relationships between policies and implementation of telehealth by FQHCs.
RAND found that live video telehealth was the most commonly used type of telehealth among FQHCs, typically used for behavioral health treatment. FQHCs also carried out store-and-forward telehealth and remote patient monitoring.
Iterviewees named several facilitators that supported telehealth implementation, including grant funding, the presence of a clinic champion, collaboration with payers, and implementation of practices to improve workflow.
The FQHC representatives said that they have several changes planned to expand telehealth implementation. These include expanding existing telehealth offerings by servicing additional sites and/or increasing volume, offering additional specialities, and modifying workflow.