Rural Providers Weigh Telehealth Investment Against Regulatory Uncertainty

Hospices are leveraging expanded telehealth options to maximize access for hard-to-reach rural patients despite lingering regulatory uncertainties.

Case in point, the Providence Institute for Human Caring last year launched a tele-palliative care program aimed at addressing rural patients’ unmet needs. Thus far, the initiative has yielded positive results, but the process hasn’t always been easy, according to Dr. Gregg VandeKieft, executive medical director of the institute’s Palliative Practice Group.

Snags along the way included dairy cows blocking staff from reaching patients.


“For the first time we’re able to offer equitable access to specialty palliative care services for patients who need and want them in this rural setting,” VandeKieft told local news. “But we often have to balance providing health care with the time schedules and welfare of livestock, crops and other realities of rural living.”

Washington-based Providence Health System provides a range of facility- and home-based care, including senior services and hospice. The company has more than 119,000 employees serving communities in six states.

The TelePC program has increased care collaboration between Providence and the patients’ other providers, including family caregivers. It has also reduced travel time for the palliative care team and curbed unnecessary patient transfers and recurring hospitalizations.


Hospice and palliative care providers have wrangled for decades with obstacles that complicate access to rural patients and make their care more expensive.

For starters, rural regions are less likely to have a Medicare-certified hospice than urban counties. The service areas of the nearest hospices may not extend far enough to reach some of the people in those zones.

When rural patients do have a provider in range, those hospices do their best to deliver care while contending with lower patient volumes, a smaller labor pool, long-travel times between home visits and the resulting travel costs.

Some of the challenges are very unique to rural areas, like livestock schedules, lack of nearby caregiver support and limited internet bandwidth capacity.

Telehealth has been an important part of improving providers’ ability to reach rural patient populations, according to Dr. Michael Fratkin, chief medical officer for ResolutionCare, a Vynca company. Fratkin founded palliative care provider ResolutionCare in 2015. Advanced care planning technology company Vynca acquired the company last year in its first move into the clinical care space.

The pressures on rural providers go beyond the logistical. A successful tele-palliative care program requires not only greater access to high-speed internet in those areas, but also the confidence of the people they serve.

Many rural residents place a lower value on telehealth services compared to the in-person care they are used to, said Fratkin.

“The advantages of telehealth are the gain of seeing people at home and instantaneously sharing space with them,” Fratkin told Hospice News. “We are not physically entering their private space, not requiring them or staff to drive. What’s most important is creating that safe space to share. There are biases that virtual care is second rate. We have to blast through these biases. They are a bigger barrier to palliative and hospice care than dairy cows.”

Then came the pandemic, and with it broad expansion of how providers can use telehealth — at least for the time being.

Rapid deployment of telemedicine during the COVID-19 public health emergency (PHE) has created “a new pathway” for bringing palliative and hospice care specialists to rural areas, according to authors of a recent report published in the JAMA Health Forum. Additional studies further support the claim that changes to telehealth policy improved access.

But without further regulatory or legislative action, those pathways will close when the federally declared emergency ends.

The U.S. Department of Health & Human Services (HHS) most recently extended the PHE period to expire in July. The agency has not indicated whether or not they will renew it.

As hospices navigate how they will use telehealth in the long-term, these uncertainties put them in a bind. Many are trying to weigh the benefits of telehealth investments against the possibility that they may soon have to shut down or cut back those programs.

One factor policymakers might need to consider is that people may now expect that these services will remain available to them.

The events of the past two years have opened the eyes of many patients to telehealth’s potential , according to Fratkin.

“The pandemic telehealth experiment is unmeasured, but what we’ve discovered by being thrust into this experiment is that I don’t think patients want to give it up,” Fratkin told Hospice News. “They discovered the value of communications technology allowing them to stay in their lives and not interrupt care. Some of these providers are running back to the status quo as if it was working, but we’re going forward, not backward in this.”

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