State must leverage technology for health of rural Nebraskans

Small Towns

By Derrik Conard, former staff member

Posted by the Scottsbluff Star-Herald on Nov. 27, 2022

The number of Americans using telehealth services surged during the COVID-19 pandemic.

National Medicare telehealth visits, for example, increased from 840,000 in 2019 to almost 53 million in 2020, according to the U.S. Department of Health and Human Services.

Unfortunately, Nebraska experienced a lower level of growth. But, if the state wants to address health care access in rural areas, telehealth services, which connect patients to health care services through videoconferencing, need to be part of the discussion.

Compared to urban counterparts, rural communities have higher rates of chronic illness, partly due to poor access to health care. This is true in Nebraska, where some rural counties lack a single primary care provider or registered nurse.

As of 2018, 20% of Nebraskans lived in rural areas. But only 8.2% of registered nurses practice there. Six counties have no registered nurses and another six counties have just one. The lack of specialty providers is even worse. Of Nebraska’s 93 counties, 57 are without an OB/GYN, 74 are without an internal medicine doctor, and 78 are without a pediatrician.

Recent hospital closures caused by financial instability have also contributed to the lack of access. While an influx of federal support during the pandemic helped keep many struggling hospitals in business, the underlying financial stress still exists.

The Bipartisan Policy Center recently published a study that found 30 hospitals in rural Nebraska have seen a decrease in revenue from patient services over the three year period between 2017 and 2020.

With access to care shrinking, and hospitals struggling with staffing levels, which can limit appointment availability, rural Nebraska needs to leverage technology. Widespread use of telehealth could help reduce rural patient challenges, such as transportation and limited provider availability, especially among specialty providers who are more prevalent in urban areas.

The use of telehealth services has been helpful in addressing access in rural communities across the country. Assisted living facilities have used the technology to allow specialists to provide care to residents, while rural clinics have been able to provide patients with integrated care during primary care visits. Other patients have used telehealth services to meet with their provider between visits, without having to leave their home.

While state lawmakers and local leaders have recently championed and approved funding for rural health care capacity growth, including the Legislature’s approval of $60 million from the American Rescue Plan Act to help expand the University of Nebraska at Kearney Rural Health Complex, there is still work to do. This includes requiring parity in reimbursements for telehealth care and improving access to high-speed internet service in rural areas.

The Federal Communications Commission (FCC) defines broadband as internet connectivity with speeds of 25 megabits per second (Mbps) download and 3 Mbps upload. An estimated 80,000 rural Nebraska residents do not have access to broadband as defined by the FCC.

Recent federal and state broadband expansion funding has required service providers to build broadband infrastructure that reaches 100 Mbps upload and 20 Mbps download speeds, which places even more rural communities outside of the broadband standard. Without a major expansion of broadband, rural adoption of telehealth services will be challenging, if not impossible.

We applaud the state’s recent efforts to address health care access in rural Nebraska. With a continued emphasis on funding and bold ideas, guaranteed parity for all telehealth services, and prioritizing broadband access, Nebraska can create an adequate virtual and physical health care network for rural residents.