For arthritis patients who live in farming communities, just getting to rheumatologist Lynne Peterson, MD’s, office in Bismarck, N.D., can take a lot of time and energy.
“Because of the shortage of rheumatologists, patients living in rural areas tend to receive inadequate rheumatologic evaluation and care,” says Dr. Peterson, whose clinic is located at Sanford Health. “They’re often referred for specialty care later in their disease course, once joint damage has already occurred. In North Dakota, travel time is significant and difficult, and exacerbated in the winter months.”
Many of Dr. Peterson’s patients need help with transportation to and from the doctor’s office, she says. One day, however, they may benefit from the services being tested in the Frontier Community Health Integration Project (FCHIP), a new program mandated by the CMS Innovation Center and the Federal Office of Rural Health Policy that’s designed to improve Medicare beneficiaries’ access to care in rural regions.
10 Hospitals; 10 Demonstrations
The Centers for Medicare and Medicaid Services (CMS) announced 10 demonstrations of how hospitals can use skilled nursing care, telehealth and ambulance services to aid rural patients. Ten critical access hospitals in Montana, North Dakota and Nevada launched the demonstrations on Aug. 1; the projects will continue for three years. The 10 hospitals were selected because 1) they are located in states where 65% of the counties have six or fewer residents per square mile, and 2) they receive funding from the Rural Hospital Flexibility Program, according to CMS.
“Medicare beneficiaries who live in frontier areas of the country sometimes travel hundreds of miles to see a doctor,” says Patrick Conway, MD, chief medical officer and principal deputy administrator at CMS. “This increases the cost of care and can discourage beneficiaries from seeking treatment.”
FCHIP’s demonstrations are designed to encourage hospitals to provide these services in sparsely populated areas. The programs will also study whether financial incentives for these services will make them more affordable for the hospitals, improve access to care for patients and improve coordination of care among providers.
Shrinking the Distance
Long distances between homes and the clinic may lead to disruptions in care for patients with chronic, rheumatic diseases who need to see their rheumatologist relatively often, says Dr. Peterson.
“The cost of transportation, frequent visits and motel expenses all contribute to the difficulty for rural patients to receive initial specialty care, as well as continuity of care,” says Dr. Peterson. It’s hard for these patients to follow through with their treatment plans because of where they live. “Drug availability, lab monitoring, biologic infusions and joint injections can all be challenges in this rural population.”
“The effort that is beginning today will look at ways to shrink the distance between the Medicare beneficiary and the care they need,” notes Dr. Conway.
Dr. Peterson supports funding for patient transportation, but she’s skeptical about the value of telehealth for her patients.
“Telemedicine is difficult in this specialty, [because] the physical examination is so important in assessing disease activity,” says Dr. Peterson. She’d rather see funding to train more nurse practitioners in rheumatologic care to help reduce rural patients’ need to see the doctor.
“Working with specialty pharmacies to deliver medications in a more timely manner to rural areas would also be helpful.”
Susan Bernstein is a freelance medical journalist based in Atlanta.
