Telehealth ‘another arrow in the quiver’ for Kansas providers, but barriers remain

TOPEKA — Kansas patients and health care providers value telehealth as a convenient and accessible option, new research shows, but they also recognize its limitations and technological challenges.

Dorothy Hughes, an assistant professor of population health and surgery at the University of Kansas School of Medicine’s Salina campus, spent 18 months studying the use of telehealth. She presented findings at a Dec. 12 forum at the Kansas Health Institute.

The research included a survey of 250 health care providers, a poll of 870 consumers, interviews with 14 providers and a series of 17 focus groups with 60 consumers, including three in Spanish.

Hughes said patients and providers liked telehealth appointments because they are easier to attend, eliminated transportation time and helped parents avoid the need for child care. People also feel more comfortable in their own homes.

“They associated being home with better access to care,” Hughes said. “They felt better able to engage with their provider, with their care. And in therapy in particular, they felt better able to open up.”

On the other hand, telehealth isn’t well-suited to all kinds of care. Some people complained about it being impersonal. And the lack of high-speed internet in some areas presents a problem.

Hughes included quotes gathered through her research with her presentation.

“I think the negative is just the internet,” said an urban-rural primary care provider. “There’s always comments about, ‘Well, I tried to do telehealth but the internet wasn’t any good.’ And struggles with getting … some of our patients on. They don’t necessarily have the newest, latest, greatest iPhone out on the market, and so that makes sometimes for a difficult phone call.”

The REACH Healthcare Foundation and United Methodist Health Ministry Fund sponsored the research. Hughes said she looked at reimbursement rates, patient experiences, workforce issues, health care quality, broadband access, barriers to implementation, what can and can’t be done via telehealth, scheduling logistics, getting the word out, and other issues.

Some of the limitations of telehealth are obvious — in-person care is necessary for physical exams, injections and group therapy, for example. But telehealth is good for basic triage, quick follow-ups, patient education, reviewing lab results and chronic care management.

“A real plus with the telehealth stuff is it allows us to engage people who can’t get here,” said a rural substance use disorder administrator. “I mean, you can imagine in a rural seven-county area, a lot of people we serve don’t have driver’s licenses or cars. A lot of times no income, so it’s hard for them to get here. But almost all of them have a smartphone.”

On patient said it is important to have the option of telehealth, “not only because it’s easy and it’s convenient, but because sometimes it’s the only option.”

Most patients and providers want the flexibility to use telehealth on a case-by-case basis if they agree it is the best option. But providers expressed concern about the need for parity in reimbursement rates.

“It costs big money to have a platform that is somewhat capable of doing what you want it to do,” said an urban inpatient pediatrician. “I don’t know what the exact policy implications of that are, but I do know that if there is a draconian reduction in the reimbursement, then those two things together could be really devastating to any small group of physicians, no matter their subspecialty.”

A rural primary care physician viewed telehealth as “another arrow in the quiver.”

“It isn’t like, ‘Hey, you know, I’d love to do this full-time every day.’ But it’s like, ‘You know, if we could get Mrs. Jones’ medications filled with the telehealth visit, it’s going to give me more time to get my charts done or see another patient, (and) it saves her the hassle of driving.’ And so in that way it’s very helpful,” the physician said.

REACH Healthcare Foundation works to provide access to quality, affordable health care for uninsured and medically underserved people. The foundation serves Allen, Johnson and Wyandotte counties in Kansas and Cass, Jackson and Lafayette counties in Missouri.

United Methodist Health Ministry Fund works to improve the health of rural and underserved communities in Kansas.

Pattie Mansur, director of communications and health policy for REACH, said she hopes the research “sparks a lot of discussion about policy avenues going forward.”

“We know there are barriers,” Mansur said. “So figuring out what is the path forward of us, whether it’s on broadband and digital equity, or whether it’s on telehealth and access to care, really adapting that mode of health delivery that has become so popular during the pandemic.”