Access to health care, including mental health services, is a challenge for rural areas, in part due to geography. When transportation infrastructure is lacking, for instance, it affects many facets of people’s lives.
“Washington County, itself, is 600 square miles,” said Rebecca Holmes, clinical director of Highlands Community Services. “That’s a lot of distance for folks who have no transportation or who are dependent upon the generosity of someone else [to get to an appointment].”
Mobility isn’t just a challenge for patients. It can be difficult to get providers in the region to begin with. Telemedicine, where medical professionals see patients through video chat, offers one solution.
In Wellmont’s rural hospitals, there are no psychiatrists present — all consultations are done via telepsych. Highlands Community Services offers telemedicine as well. Its primary children’s psychiatrist, for instance, is only on-site one week per month and provides services through telemedicine the rest of the time.
“The prediction is that [for] the future of health care, you’re going to have a bunch of virtual care centers, so you’re not trying to get those providers to each patient,” Wellmont Health System Vice President Sue Lindenbusch said.
But as with any new technology — especially in highly regulated industries like health care — hurdles remain.
“Telepsychiatry could be a blessing to availability in rural areas,” said Dr. Joe Parks of the National Council for Behavioral Health. “But there’s been significant regulatory barriers involving getting licensed in multiple states or having to see people face to face if you’re prescribing certain medications.”
Lindenbusch cited high costs and a lack of reimbursement at Wellmont’s larger hospitals as challenges. Clinical director Rebecca Holmes said Highlands has used telemedicine to offer temporary staff when it’s faced a shortage of psychiatrists, but described the option as “exorbitantly expensive.”
U.S. Sen. Tim Kaine, D-Va. also noted restrictions on telemedicine but said the goal of the bipartisan CONNECT for Health Act — also supported by U.S. Sen. Mark Warner, D-Va. — is to lift many of them.
“Behavioral health, I think, is a promising area for telemedicine,” he said. “We need to make sure the federal reimbursement schedules account for that.”