With many states operating under ‘stay at home’ orders and hospitals in major cities facing an overwhelming volume of patients, the COVID-19 pandemic is changing daily life in the US. 

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  <h2>Introduction</h2>

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    With many states operating under &lsquo;stay at home&rsquo; orders and
    hospitals in major cities facing an overwhelming volume of patients, the
    COVID-19 pandemic is changing daily life in the US. Now that hospitals are
    delaying elective surgeries, there is a great deal of
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    over lost revenue and the high cost of coronavirus care. The industry is
    feeling the impact at every level and senior leadership is confronting new
    strategic, financial and clinical questions about the future of healthcare.
    Each sector of the healthcare industry is facing similar challenges, while
    also adapting to their own unique experiences.
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    On March 30<sup>th</sup>, the Federal Communications Commission (FCC)
    Chairman presented a draft order to use $200 million of the recently
    approved economic stimulus package to expand Telehealth services across the
    country. On April 3<sup>rd</sup>, the FCC adopted the program and will use
    funds from the $2 trillion stimulus package that can be distributed to
    healthcare providers to help organizations secure broadband internet and the
    tech devices necessary to support Telehealth services. Additionally, the FCC
    approved a separate $100 million pilot program designed to offset Telehealth
    services for low-income patients and veterans over a three-year period. For
    healthcare executives, particularly in rural and critical access healthcare
    settings, the implementation of these Telehealth solutions play a critical
    role in best serving patients during this challenging time, as well as into
    the future.
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  <h2>Risks for Rural Health</h2>

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    Prior to the global outbreak of COVID-19,
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          >rural healthcare organizations were already struggling</a
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    financially due to the geographically shifting patient population, changing
    Medicare reimbursements and the many rural patients lacking in high-paying
    private insurance. More than 120 rural hospitals closed their doors over the
    last decade, and those that remain open rely heavily on high-revenue
    services, such as lab tests, physical therapy and elective surgeries.
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    While the added financial strain created by fighting the coronavirus could
    prove too much for some rural facilities to sustain, many of these
    organizations are tackling these obstacles using innovation.
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    &ldquo;The silver lining in this pandemic is the rapid forced movement to a
    Telehealth platform that will better position the organization for the
    future of virtual care,&rdquo; said Bren Lowe, Chief Executive Officer for
    Star Valley Health in Afton, Wyoming.
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  <h2>Telehealth: The Basics</h2>

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    As defined by the Health Resources Services Administration, Telehealth is
    the use of electronic information and telecommunications technologies to
    support long-distance clinical health care, patient and professional
    health-related education, public health and health administration. In 2019,
    The Centers for Medicare &amp; Medicaid Services (CMS) increased its
    Telehealth reimbursement for Medicare Advantage customers, which covers more
    than 30% of all Medicare recipients. However, even with this increase, it is
    estimated only 15% of providers utilize Telehealth services as standard
    practice. CMS predicted this number to increase going forward, estimating
    that, by 2023, the Telehealth market in the US will grow to greater than $13
    billion. The emergence of the coronavirus and the spreading global pandemic
    will change those estimations; many organizations, particularly in rural
    areas, are already making changes to take advantage of the available
    technology.
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    &ldquo;Telehealth played an insignificant role in our overall care delivery
    model prior to the crisis,&rdquo; said Greg Ruberg, President/CEO for Lake
    View Hospital in Two Harbors, Minnesota. &ldquo;We had two agreements for
    Telehealth services with our system, but both were discontinued due to
    provider changes prior to the crisis. We have implemented Telehealth
    in our medical clinic within [since the start of the pandemic] and it has
    taken off.&rdquo;
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    &ldquo;Our providers have embraced the new approach and our patients have
    accepted it as well. It is helping to fill the gap from significant
    reductions in face to face clinic visits related to COVID-19,&rdquo; Ruberg
    said. &ldquo;We are working on implementing this model for our urgent care
    service in our ED.&rdquo;
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  <h2>Telehealth and Containing COVID-19</h2>

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    In order to make Telehealth more available during the COVID-19 crisis,
    federal privacy regulations have been relaxed and payment policies are
    expanding. Prior to March 2020, Medicare Telehealth coverage was limited in
    scope and availability, only covering older adults living in rural areas and
    only covering patients who had an established provider for Telehealth care
    that took place in a rural healthcare facility. Now, the coverage includes
    office visits conducted via Telehealth technology where services are
    provided by physicians and or other providers, including nurse
    practitioners, clinical psychologists and licensed clinical social workers.
    Additionally, the Health and Human Services (HHS) Office is waiving
    Medicare&rsquo;s cost-sharing requirements for COVID-19 treatment that is
    delivered via Telehealth from a doctor&rsquo;s office or a hospital
    emergency room.
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    &ldquo;Physicians are using various sources of Telehealth in most clinics
    over the last few days,&rdquo; said John Bishop, Chief Executive Officer for
    Marcus Daly Memorial Hospital in Hamilton, Montana. &ldquo;The organization
    is currently in the process of rolling out a uniform solution that will
    sustain beyond this event.&rdquo;
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    Health organizations are using this technology in a variety of ways,
    including sharing intelligence, education and treating patients. Here are a
    few ways Telehealth is making a contribution:
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  <h2><em>Reducing the risk to care providers. </em></h2>

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    While it is impossible to know exactly how hard providers have been hit at
    this point because the Centers for Disease Control and Prevention (CDC) has
    not released nationwide data, it is estimated that more than 60 infections
    among healthcare works have been reported. As the COVID-19 virus continues
    to spread, primary care providers are on the front lines. The more exposure
    they have to large groups, large numbers of patients, the more at-risk they
    become. With the use of Telehealth technology, provider organizations can
    divide patients into the at-risk and not-at-risk groups, allowing them to
    take steps to reduce the risk for both providers and patients.
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    <em
      >Providing continued care for well patients and the sickest patients.
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    &ldquo;We have transitioned rapidly to the majority of all clinic visits
    being Telehealth delivered,&rdquo; said Star Valley Health CEO Lowe.
    &ldquo;This includes all primary care and specialty clinics. This will
    continue for the foreseeable future.&rdquo;
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    Many organizations are utilizing Telehealth technology to continue to serve
    their well-patient population while allowing those individuals to keep a
    safe distance from possibly infected patient groups. For the sickest
    intensive care unit (ICU) patients, Telehealth services allow improved
    patient monitoring while keeping those patients safe from repeated contact
    with providers. The ability to remotely triage COVID-19 patients and to
    convert standard ambulatory health visits to Telehealth visits also allows
    providers to employ social distancing and keep patients away from crowds,
    while continuing to provide care.
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  <h2><em>Driving innovation and education. </em></h2>

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    Today, the capabilities of Telehealth technology provide the opportunity for
    enhancing the
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    >, as well as continuing to advance healthcare IT innovation overall. Most
    Telehealth solutions include dashboards, e-scheduling and analytics tracking
    capabilities that allow organizations to analyze operations at a deeper
    level. Telehealth can also create a virtual network, establishing
    opportunities for collaboration, secure communication and e-prescribing.
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    While this technology presents outstanding opportunities, education and
    operational change will be needed to support it. From the requirement of
    additional servers to training for providers and patients in using online
    tools, the movement toward Telehealth will require infrastructure and
    commitment to continue to push forward.
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  <h2><em>Paving a path forward. </em></h2>

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    &ldquo;We likely will see a patient shift toward adopting this
    solution,&rdquo; said Marcus Daly CEO Bishop. &ldquo;Our
    community is one that is significantly older than average and prior to this
    event there was a feeling that you had to be in the room with your doctor to
    receive high quality medicine.  While it&#39;s hard to see out of our
    current mindset, I would imagine that many patients that would not have
    considered a Telehealth solution prior to COVID-19 will now be more open to
    such solutions.&rdquo;
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    Prior to the immense ramping-up of Telehealth programs in 2020, many
    provider organizations believed older patients would not feel comfortable
    with virtual care; there were concerns about older patients&rsquo;
    familiarity with online tools and their ability to use and understand
    technology. Today, providers report that their older patients are
    increasingly comfortable with technology and are as quick to request online
    visits as their millennial patients.
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    The most common questions for the future now revolve around spotty access to
    broadband and poor cellular service in some parts of the country &ndash;
    particularly in remote, rural areas &ndash; as well as inconsistent access
    to cell phones and other technology. As these questions are answered, the
    path forward for Telehealth will become more clear and provide options for a
    much larger range of patients.
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  <h2>An Uncertain Time</h2>

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    While the rapid adoption of Telehealth services is of great benefit to
    providers and patients, there continue to be hurdles to the expansion of
    this type of care. For example, state licensing rules stipulate that a
    provider can only provide Telehealth care to patients in that same state.
    This leads physicians to the choice between paying for multiple state
    licenses or finding themselves unable to treat patients in neighboring
    states where the COVID-19 outbreak may be more severe and access to care may
    be more restricted. New Jersey recently passed a law allowing New Jersey
    providers in good standing to see patients via Telehealth visit as long as
    they have an established patient-provider relationship. With cases of
    COVID-19 still on the rise, other states have followed suit.
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    This healthcare crisis is
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          >changing the way medicine is perceived and practiced</a
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    across the world. To provide education and support during the
    transition to telemedicine in rural and critical access healthcare
    organizations, Cejka Search is partnering with Todd Forkel, CEO of Avera St.
    Luke&#39;s and Avera St. Mary&#39;s in Sioux Falls, South Dakota to present
    a webinar on Thursday, April 23. To register for the webinar event,
    sign up anytime prior to the event
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        ><a href="https://register.gotowebinar.com/register/7166246660714071052"
          >online</a
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    >.
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    &ldquo;This surge of Telehealth will disrupt our industry going
    forward,&rdquo; said Lake View CEO Ruberg. &ldquo;There will benefits and
    risks for traditional health care organizations and we will certainly face
    new competition. We will have to innovate and be competitive to remain
    financially viable and relevant with primary care.&rdquo;
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The Rapid Rise of Telehealth in Rural Healthcare