In some parts of the rural United States, accessing in-person health care can feel impossible. Local emergency rooms and specialists might be nonexistent, and a trip to the clinic can take hours.
Telehealth has changed the game. Stephen Martin, a family physician and addiction medicine specialist, has witnessed how the recent influx of virtual appointments has increased access to medical care for rural patients from his practice in Barre, Mass. People seeking long-term addiction treatment who may have shied away from health care in the past because of stigma in a small town or lack of transportation can now receive substantive treatment.
But no one knows how long telehealth will remain a viable option for many people on Medicare. Policies introduced during the COVID-19 pandemic made it easier for people in rural America to access virtual care, but some of these programs are now set to expire early next year.
While bipartisan support for the extensions remains, legislation that could implement them long-term is currently in limbo. The Medicare benefits, which were set to expire on December 31, were temporarily extended to March 31, 2025, under an emergency government funding bill signed by President Joe Biden on December 21. Come April, if the benefits aren’t extended again, many people living in rural America will face renewed hurdles to accessible care.
Health care in rural areas can be hard to access
Physician shortages, hospital closures, and the shuttering of critical services, such as labor and delivery care, have made it increasingly difficult to find reliable health care in rural areas (SN: 12/11/24). According to the Center for Healthcare Quality and Payment Reform, almost 200 rural hospitals have closed since 2005, leaving millions of people without emergency care or inpatient services in their communities. Late insurance payments and tight profit margins have left 360 more rural hospitals at risk of immediate closure. As of this year, there are about 1,200 rural hospitals throughout the country.
When these hospitals vanish, the patients they leave behind still fall ill and require care. People living in rural areas across the United States are more likely to die from heart disease, cancer, chronic lower respiratory disease and stroke than their urban counterparts, researchers reported in May in Morbidity and Mortality Weekly Report. Sixty-five percent of nonmetropolitan counties across the country lack a psychiatrist, and rural patients have higher rates of suicide and depression than urban residents, other studies have found.
If you don’t get along with the only doctor in town, Martin says, you’re in a tough spot. “You’re left to the idiosyncrasies and vantage points of any small number of practitioners in that area. So if those practitioners aren’t interested in addiction, you won’t have addiction care. If they’re not interested in mental health, you won’t have mental health care.”
Unsurprisingly, transportation to different providers is often a limiting factor for rural patients. For the millions of people living in rural parts of the country, it can take nearly twice as long to reach a hospital than it does for urban residents. Numbers vary wildly, but the average car travel time to the nearest hospital for someone in a rural area is 17 minutes; the average urban dweller needs just about 10 minutes. For people living in remote, hard-to-reach areas, it can take hours to reach in-person care.
There are patients who “literally have to take off an entire day of work to come and see us,” says U.S. Representative Gregory Murphy, a urologist who represents North Carolina’s 3rd District. “So many of the areas, sadly enough, in eastern North Carolina are rural and impoverished areas. So for people to lose half a day or a full day of work, it is a lot of lost wages.”
Telehealth legislation has been a boon for rural residents
In March 2020, isolation, quarantine, and fear of COVID-19 kept people away from healthcare centers. In response, Congress passed several temporary acts that expanded Medicare’s coverage of virtual care — for instance, patients could receive mental or behavioral telehealth care without visiting in person after an initial appointment. Telehealth use boomed. In-person appointments shifted to virtual ones. The number of telehealth users has since dropped but remains higher than pre-pandemic levels.
“Telemedicine is critical for access,” Seaman says. Finding a primary care doctor, a specialist to help manage chronic conditions, and a mental health practitioner might be a tall order in some rural counties.
As the data roll in, scientists are learning that telehealth has the power to facilitate a diverse array of treatments. For example, doctors can virtually rehabilitate patients with chronic obstructive pulmonary disease, a lung disease with high prevalence in rural areas, and virtual mental health care can reduce depression symptoms and improve quality of life.
And for patients with opioid use disorder, virtual care can actually boost treatment retention, researchers reported in the December Journal of Substance Use and Addiction Treatment. Patients will stay and seek care for longer when the barriers are fewer.
Additionally, many people living in rural America might lack the technology necessary to chat over video. In 2020, the Federal Communications Commission reported that about 22 percent of rural Americans and 28 percent of people in what the agency classifies as Tribal Lands lacked broadband coverage, which is internet access quick enough to accomplish basic web-browsing tasks.
Researchers, policymakers, and healthcare workers have also shared concerns about telehealth’s impact on the quality of care. Some argue that technical difficulties during the pandemic inhibited certain care routines. Others argue that communication is impacted due to the loss of nonverbal cues from patients and clinicians.
