Rapid Scale‐Up of Telehealth During the COVID‐19 Pandemic and Implications for Subspecialty Care in Rural Areas

Dr. Borders, I work at a tertiary care university hospital as a pediatric subspecialist in adolescent eating disorders. Our medical center serves much of the west coast of the United States, including rural areas throughout Central Valley and all of northern California. Access to subspecialty care for people living in rural areas remains a significant challenge.1 Patients and families from rural locations may need to travel several hours to access subspecialty care. Amid the COVID-19 pandemic, the entire state of California was placed under a shelter-in-place order on March 19, 2020. In order to mitigate the risks of exposures to COVID-19, our medical center reduced in-person visits to our outpatient subspecialty clinics, trained providers in telehealth visits, and scaled-up telehealth visits. All of our outpatient mental health visits were converted exclusively to telehealth visits. Likewise, many subspeciality clinics throughout the United States and world have scaled up telehealth visits in response to the coronavirus pandemic.2 The rapid scale-up of telehealth during the COVID-19 pandemic may have long-term implications for access to subspecialty care for people living in rural communities. As more providers are now trained and more practices are now equipped with telehealth infrastructure, these services will likely continue to be offered beyond the pandemic. Telehealth may offer several benefits for rural health, including (1) providing expanded access to services, (2) fostering the integration of rural primary care and remote subspecialty services,3 and (3) enabling more effective care management.4 Expansion of mental health services in particular may be of benefit to rural communities, as deaths due to suicide, drugs, and alcohol occur at higher rates in rural compared to urban communities, yet there remains a paucity of mental health providers in rural locations.4 In order for telehealth to be successfully implemented in rural areas, coverage and reimbursement, licensure, Internet access, and privacy and security will need to be adequately addressed.4 Given the rapid transition to telehealth by large medical centers during the COVID-19 pandemic, these are issues that insurance companies and policy makers are actively addressing. Greater access to subspecialty care for people in rural areas via telehealth may be an unexpected consequence of the COVID-19 pandemic.