Reclassification impacts access to health care for millions of rural older adults

Telemedicine equipment

Photo by Kevin Souza via Flickr

Back in January, the FCC announced $400 million in funding for creating and expanding rural broadband networks to support telemedicine in medically underserved regions.

Their HealthCare Connect program links urban medical centers and rural clinics, providing real-time consults with immediate access to a patient’s electronic medical records. Since adults 65 and older comprise roughly 14.4 percent of rural residents, this would appear to be an ideal use of technology to contain costs, facilitate care and improve preventive services.

However, last month, the U.S. Office of Management and Budget reclassified Metropolitan Statistical area delineations and moving 97 counties from rural to metropolitan designation. That eliminates Medicare reimbursement for telemedicine services in those areas. Yet just the day before, these same seniors were eligible, avoiding long-distance travel for consults or even basic health check ups.

The American Telemedicine Association is furious over this move, especially since Medicare has yet to grandfather in these counties. So while the FCC is working to make access easier, CMS policy penalizes non-urban Medicare beneficiaries, according to Jonathan Linkous, chief executive officer of the ATA. The organization is working with members of Congress on several bills addressing this oversight and expanding services, but it’s a slow process. The American Medical Association calls telemedicine “a pathway to the future,” urging federal and state governments to stop obstructing its growth.

Medicaid reimbursement for these same services are left up to the states. To date, 35 states allow for at least some telehealth service reimbursement, including mental health care.

Here’s the list of the formerly eligible counties that now lie on the wrong side of the map’s dotted line. If any of them are in your coverage area, consider how many elderly are affected. How will they receive care for routine visits? What will happen if a specialist consult is needed? How are local providers reacting? What is the impact on hospital admissions/discharges? Costs? Is that county’s Congressional rep part of the effort to remove obstacles?

Policy and reimbursement issues can seem convoluted and archaic; yet their impact is very real.

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