FRANKFORT, Ky. -- Many rural health clinics primarily serving Medicaid recipients as well as the uninsured are navigating ways to help their patients manage chronic conditions such as diabetes and high blood pressure during the pandemic. One million Kentuckians see a health professional at more than ninety rural health clinics across the state.

David Bolt, chief executive of the Kentucky Primary Care Association, said rural clinics increasingly rely on telehealth phone and video appointments amid COVID-19, "and the concern there is that, in a lot of rural areas of the state, we still don't have appropriate connectivity in that last mile for people to take advantage of it."

Kentucky currently ranks 44th among states for broadband access, and statewide health organizations are calling for federal funding to expand reliable internet access in rural areas as part of continued coronavirus relief efforts.

With many patients continuing to avoid non-urgent care, clinic revenues are expected to decline as COVID-19 continues. But despite the challenging road ahead, Bolt said clinics are determined to continue providing primary care in communities hardest-hit by unemployment because of the pandemic.

"Some of these clinics have jumped in to continue to build primary-care operations in communities that have need," he said.

In April, Congress approved a $225 million grant program specifically aimed at helping federally certified rural health clinics cover coronavirus-related expenses, including testing.


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Telehealth has been key to health care in the wake of the COVID-19 pandemic, but some of the flexibilities for this type of care for Medicare patients could expire soon.

A new report from the Bipartisan Policy Center details how Congress can improve telehealth.

Without action from Congress, telehealth provisions for Medicare expire at the end of 2024.

Maya Sandalow, senior policy analyst with the Bipartisan Policy Center, said telehealth is especially important for rural states like Idaho.

"We know that patients have to travel way farther than folks in urban areas to access care," said Sandalow. "Hospitals are shutting down and struggling to stay afloat. And so telehealth is really an important part of this puzzle when it comes to helping people living in rural areas to access care."

Sandalow said Congress looks likely to give a two-year extension to telehealth provisions, but she also noted that members should consider ways to ensure people can access this care.

The report recommends three policies for Congress to consider if it extends telehealth provisions.

First, she said policymakers need to consider the cost - by mandating a study from the Centers for Medicare and Medicaid Services - because there is some disagreement about whether it costs more than in-person care.

Sandalow said CMS should also set up a way to track telehealth companies.

"These companies are really important for expanding access to care," said Sandalow, "but there are some quality concerns associated with some of these companies."

Lastly, Sandalow said Congress should make some of the policies around telehealth permanent, such as doing away with location restrictions.

She said telemedicine is going to continue to be important to the health care landscape going forward.

"Research finds that it can be really high quality, equally good as compared to in person care," said Sandalow. "And we're living in a behavioral health crisis and any measures to expand access to care are really important."




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North Carolina must increase its crisis response capacity for long-term success, according to a new report by the mental-health policy group Inseparable. The report analyzes 988 crisis lifeline responses in every state and proposes improvements.

One key area it says requires attention in North Carolina is the need for more crisis-response mobile units and beds. Kelly Crosbie, director of the Division of Mental Health, Developmental Disabilities and Substance Use Services at the North Carolina Department of Health and Human Services, acknowledged this challenge and said funding from the General Assembly is addressing the need.

"So, now we have 19 'urgent cares' opening across the state," she said. "In the community crisis center space, we've added about 64 new beds for adults and 44 new beds for children."

The report shows an 81% call capacity rate, with a recommended goal of 90%. Crosbie said current numbers are higher, with call capacity at 98% and calls being answered in about 14 seconds. North Carolina's 988 line receives around 8,000 calls monthly.

In order to sustain this progress for the long term, Crosbie said, the 988 system will need sustainable funding.

"We really need insurers to recognize this as an appropriate level of care and to cover it. So they all cover 'urgent cares' now, right? Folks who go to an urgent care, and you have Aetna or Blue Cross, they're going to cover it," she said. "You go to a mental-health 'urgent care'; that should be covered as well."

Angela Kimball, chief advocacy officer for the group Inseparable, said the report calls on state legislatures to focus on creating sustainable funding sources and accountability measures for their crisis response systems.

"By having these accountability pieces," she said, "this allows legislators to oversee the system over the long haul, and to set up the structures for continuous learning, continuous system improvement."

She said data collection, annual reporting and coordination between the 988 and 911 systems are ways states can make them more accountable.

New York doctors are advising people how to stay healthy in the summer heat.

Temperatures across the state will reach the high 80s and mid-90s in the coming days. Some climatologists estimate 2024 will overtake 2023 as the hottest year on record, and New York's average temperature has risen 3 degrees since the 1970s.

Dr. Steven Foulis, a physician at
UBMD Primary Care, said people need to always stay hydrated.

"When you sweat, you lose a good deal of salts and other solutes through the sweat," he said, "so being able to replete those with whether it be a sports drink or really, any drink that has electrolytes in it will be an important thing to replete what your body is losing during warm days."

Foulis said people need to wear sunscreen when they're outdoors, since some aren't aware of the risks direct sun exposure poses. However, he added, this shouldn't stop anyone from getting away from their screens to enjoy the outdoors. New York Gov. Kathy Hochul's "Get Offline, Get Outside" campaign champions this by making all state park pools free this summer.

Not staying hydrated can lead to heat stroke or heat exhaustion, in turn leading to an emergency room visit. A Centers for Disease Control and Prevention study finds heat-related ER visits rose in 2023.

Dr. Donna O'Shea, chief medical officer for population health at UnitedHealthcare, said virtual care can help you decide whether a situation is serious enough to seek emergency care.

"You can decide, with a knowledgeable caregiver, 'Do I need more?' Most of the time, if it's related to hydration and heat stroke, if you're able to keep fluids down, virtual care can help determine how much, how long to wait before you go to the emergency room," she said. "Same thing even for sunburns or for bike safety."

She added that using virtual care can be a less time-consuming and less expensive option than going directly to a hospital. While telehealth can cost around $50, an in-person emergency room visit can cost around $2,700.