How Virtual Visits Are Bridging the Disparity Gap in Rural America

Key Takeaways

  • Rural communities struggle with access to quality healthcare because of their geographic isolation.
  • The health disparity in rural populations has led to higher rates of chronic diseases and early mortality compared to their urban counterparts.
  • Telemedicine can effectively mitigate many barriers to quality healthcare and improve patient outcomes in these communities.
  • The benefits of telemedicine for rural patients include reduced travel times and expenses, better access to specialty care, improved chronic disease management, and decreased hospitalization rates.
  • In addition, telemedicine platforms can help patients avoid unnecessary emergency department visits by providing around-the-clock treatment for acute illnesses.
  • Patients who see a virtual healthcare provider have lower out-of-pocket costs than those who have in-person visits.
  • Barriers remain to the widespread adoption of telemedicine in rural areas, such as unreliable internet access and a lack of digital literacy.
  • The future of rural telemedicine is promising; ongoing technological advances, improved rural internet infrastructure, and streamlined access to quality care will ensure that those living in rural areas receive the best possible healthcare. 

Rural Health Disparities

Rural populations, comprising 20% of the US population, have long struggled with limited access to healthcare compared to their urban counterparts. Rural communities are often geographically isolated, have fewer healthcare providers, lack public transportation, and have higher rates of poverty. These factors contribute to disparities in access to quality healthcare services in these areas. 

This disparity is reflected in the higher prevalence of diabetes, heart disease, obesity, and other chronic diseases in rural America. According to Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association, published in 2020, people from rural communities are 40% more likely to have heart disease and 30% more likely to have a stroke compared to those who live in urban areas. 

Studies show rural areas have a higher all-cause mortality rate across all ethnic groups and all age groups when compared to urban areas. This divide has been present for years and continues to expand. A key factor in this divide is the lack of access to quality healthcare. 

I have practiced family medicine at rural health clinics for most of my career. I know firsthand the challenges these patients face. However, the increasing availability of telemedicine in rural areas is changing the healthcare dynamic and bridging the disparity gap. 

Traditional Barriers to Healthcare Access in Rural America

The lack of reliable, affordable transportation is one of the most detrimental barriers to healthcare in rural communities. Public transportation is often limited or non-existent, and private transportation options can be prohibitively expensive for individuals who live on a fixed income. Many people in rural areas can’t obtain a driver’s license because of their poor health. They must rely on family, friends, or church organizations to transport them to doctor visits. The most common reason patients miss appointments at my clinic is a lack of transportation. 

Being “housebound” is another barrier to rural healthcare access. Some people, especially those older than 65, may be unable to physically leave their homes because of a stroke or heart failure. These patients, who most need medical care, often cannot access it.  While some rural healthcare providers offer home visits for these homebound patients, it’s no longer a common practice. 

A shortage of primary care providers in rural communities makes access to basic primary care services difficult for patients.  Although 20% of the US population resides in rural communities, only 10% of US physicians practice medicine in these areas. Attracting primary care physicians to rural areas is challenging, partly due to the lack of supporting medical specialists. 

A lack of specialty care in rural areas adversely affects patients as well. Patients who require a specialist, such as a cardiologist, may drive for hours across winding rural roads to reach the nearest cardiology clinic, worsening the issue of limited transportation. 

After-hours care in rural communities is often only available in the emergency department (ED), resulting in the overutilization of emergency departments for non-emergency issues. Rural EDs are flooded with patients who have mild respiratory illnesses or other mild urgent care issues simply because there’s nowhere else to go. 

Unavailable after-hours care also affects chronic disease management. Many people forego chronic care or preventive health visits because they work and can’t attend doctors’ appointments during regular business hours. Patients may also face childcare challenges that inhibit their ability to seek preventive care services. 

The most significant health disparity in rural communities may be the lack of mental health services. Rural residents have a disproportionately higher rate of mental health disorders and suicide and a lower rate of available mental health providers compared to urban residents. 

People in rural areas have higher poverty rates and are more likely to be uninsured or underinsured. They may be unable to afford office visits, copays, and other out-of-pocket healthcare costs; because of this, they rarely seek healthcare. 

Regional Hospital Campus serving as main healthcare facility for regional area.

Source: iStockPhoto

How Telemedicine is Bridging the Disparity Gap

The use of telemedicine is rapidly expanding in rural areas. Rural federally qualified health centers conducted 4.9 million telemedicine visits in 2021, according to the Rural Federally Qualified Health Centers Financial and Operational Performance Analysis for 2018-2021. Forty-four percent of rural Medicare recipients utilized telemedicine during that same period. 

Telemedicine plays a vital role in improving both healthcare access and disease outcomes in rural areas by overcoming the traditional barriers to quality healthcare. The authors of a 2024 comprehensive review of rural telemedicine, published in Cureus, concluded:

“Geographical accessibility is vastly improved as telemedicine extends healthcare reach to remote and underserved areas, while temporal accessibility is enhanced through round-the-clock availability. Moreover, telemedicine effectively mitigates financial, sociocultural, and infrastructural barriers, promoting health equity and improving health outcomes.”

Reduced Travel Time and Expenses

Telemedicine enables rural patients to schedule appointments with their primary care provider or specialist from their homes via video chats or phone calls. They can communicate with their provider via platform messaging or asynchronous modalities between scheduled visits. 

Telemedicine allows patients to access quality medical care even in the absence of reliable transportation. For patients who are physically unable to leave their homes due to medical conditions, telemedicine provides a more reliable alternative to traditional in-home visits from a primary care provider. 

Improved Access to Specialty Care

Many specialty services have traditionally been unavailable in rural areas. Telemedicine is changing that. Patients can now access specialty clinics from home. Fully staffed mobile health units and specialty ‘hubs”  located in rural communities also offer telemedicine visits with specialists at larger hospitals. 

Rural hospitals can now communicate directly with specialists from tertiary care hospitals – larger urban hospitals that offer advanced treatment options for complex medical conditions. These specialists can evaluate and treat patients via video, potentially minimizing the need for unnecessary transfers of patients out of their local hospital and improving patient outcomes. 

Specialty telemedicine services in rural hospitals expanded exponentially during the COVID-19 pandemic out of necessity. Specialists from tertiary care hospitals provide care via live video-conferencing between the patient, the healthcare provider, and the specialist. Specialists can also monitor the patient’s vitals and important health data remotely. 

A wide range of specialty healthcare services is now available to rural residents, including:

  • Cardiology
  • Dermatology
  • Neurology
  • Rheumatology
  • Oncology
  • Radiology
  • Ophthalmology
  • Substance use disorder services
  • Dentistry
  • Obstetrics
  • Remote robotic surgery
  • Tele-ICU care
  • Tele-stroke care

Unfortunately, rural communities are losing their local hospitals at an alarming rate – 146 rural hospitals closed or stopped providing inpatient services between 2005 and 2023, according to the USDA. Low patient volume, sicker patients, dwindling funding, and high rates of uninsured patients are all factors in rural hospital closures. These small hospitals are the cornerstone of healthcare in rural areas. When one closes, it’s devastating to the entire community. 

Telemedicine services can help save these vital healthcare centers.  By expanding patient services, retaining local patients, streamlining care, and reducing costs, telemedicine solves many of the problems plaguing rural hospitals. 

Reduced ER visits and hospitalizations 

Rural residents with health concerns outside regular business hours can see a telemedicine healthcare provider on demand, 24 hours a day, 7 days a week. Urgent needs can be addressed promptly without requiring an expensive emergency department trip, reducing inappropriate emergency department visits. The timely treatment of acute illnesses can also reduce hospitalizations. 

Improved Access to Preventive Care and Chronic Care Management 

Chronic disease rates are soaring. According to the most recent CDC data, 6 in 10 Americans have at least one chronic illness, and 4 in 10 have more than one.  Those living in rural areas have a significantly higher rate of chronic disease compared to their urban counterparts. 

Our healthcare system is designed to be reactive rather than preventive. Due to the limited access to healthcare providers and the potentially high costs, many people living in rural areas only seek medical attention when they develop urgent symptoms. Serious chronic health conditions, such as diabetes or heart disease, may only be recognized once the patient becomes extremely ill. 

Prevention of chronic diseases has been shown to lower healthcare costs by decreasing hospitalizations and emergency room (ER) visits, as well as reducing the need for expensive medications. Additionally, the quality of life for many patients would significantly improve if they could avoid chronic diseases.

Telemedicine is crucial in transforming the current healthcare landscape, particularly in rural areas. Imagine having immediate access to a healthcare provider without long waits, long drives, and high costs. Imagine being able to talk to a nutritionist about a healthy diet or a counselor about your mental health needs on demand. These scenarios are rare in rural medicine.

Under the traditional healthcare model, patients often wait months for a 15-minute chronic care visit, with no communication between visits with their healthcare provider and no interim monitoring of essential health data.

A great example of how telemedicine enhances the quality of chronic care is seen in diabetes management. Patients can now get continuous glucose monitors that automatically relay glucose levels to their healthcare provider. Suppose glucose levels become too high or too low. In that case, the patient and provider can communicate in real time about any necessary adjustments to diet or medication, regardless of when their next appointment is. 

Another example is the treatment of hypertension. Hypertension is a leading cause of heart attacks and strokes. Of the US adults who have hypertension, about 70% remain uncontrolled under the current healthcare model. Patients can access home blood pressure monitoring devices that function similarly to continuous glucose monitors. Blood pressure trends are sent directly to the healthcare provider, who can make recommendations now instead of waiting until the next 6-month chronic care appointment. 

The CDC estimates that the majority of chronic illnesses and premature deaths could be prevented with lifestyle changes alone, such as quitting smoking and alcohol, getting more physical activity, and eating a healthier diet. Many telemed platforms offer nutritional and tobacco cessation support, as well as alcohol cessation counseling. Ongoing lifestyle support from experts via telemedicine could significantly reduce the rates of chronic disease and early mortality seen in rural populations. 

Streamlined Care at a Reduced Cost

Telehealth visits have been estimated to cost one-third to one-quarter less than in-person visits. Many rural patients avoid seeking healthcare because of inadequate insurance. Virtual visits offer a more affordable option. In addition to the cost of the visit, patients can avoid expensive transportation costs, including gas, tolls, and vehicle wear. 

Barriers That Remain

Many rural areas still lack reliable internet; it’s estimated that only 55% to 63% of rural residents have access to moderate or high-speed internet.  Without high-quality internet, telemedicine services are limited. Investing in rural internet infrastructure is imperative. 

Many people in rural areas aren’t digitally literate, given the lack of reliable internet access. Digital literacy is necessary for the full utilization of telemedicine services. Telemedicine platforms should be user-friendly and provide free, online, easy-to-navigate tutorials. Mobile health units and ‘hubs” in remote communities can help provide telemedicine services and digital education to those unable to connect with telemedicine platforms. 

Regulatory barriers and reimbursement inconsistencies remain major challenges for the growth of rural telemedicine. According to the Financial Impact of Telehealth: Rural Chief Financial Officer Perspectives, Medicare reimburses telehealth services at lower rates than comparable in-person visits at Rural Health Clinics (RCHs). 

Patient uncertainty may be the most significant barrier to the widespread use of rural telemedicine services. Rural patients may be concerned about health data privacy, may resist change, or may be uncomfortable adopting new technology. Ongoing telemedicine education directed toward our rural populations would help lower this barrier. 

The Future of  Rural Telemedicine

Telemedicine is a game-changer for healthcare, particularly in rural communities. As telemedicine continues to evolve and adopt new technologies, exciting new possibilities are on the horizon, such as:

  • Better integration of telemedicine platforms into existing EHRs
  • Hybrid models that combine regular telemedicine care with yearly in-person visits. 
  • Expanded educational opportunities to help older Americans in rural areas become comfortable with telemedicine functionality. 
  • Improved access to telepsychiatry to address the mental health crisis in rural America
  • Seamless integration of AI technology into telemedicine visits
  • Continuous health monitoring using new technology that would allow the healthcare provider to manage chronic diseases more effectively
  • Expansion of telemedicine services at all rural hospitals to include such services as tele-ICU or tele-stroke care.
  • Virtual reality adoption for services such as physical therapy and behavioral counseling 

Telemedicine is revolutionizing healthcare.  No other sector has seen greater benefits than rural communities, and the future possibilities are limitless. The disparities in rural areas may one day be non-existent, and everyone will have access to top-notch, timely, quality healthcare regardless of their zip code.