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 detailed how Congress could improve telehealth. Without action from Congress, telehealth provisions for Medicare expire at the end of this year.

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

"We know that patients have to travel way farther than folks in urban areas to access care," Sandalow observed. "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 noted Congress looks likely to give a two-year extension to telehealth provisions but she also urged members to consider ways to ensure people can access care.

If the extension happens, the report recommended Congress consider the cost of telehealth versus in-person care, the possibility of tracking telehealth companies' quality of care and making some policies permanent.

Jonathan Neufeld, director of the Great Plains Telehealth Resource and Assistance Center at the University of Minnesota, said one thing at stake is the ability for certain providers to bill Medicare for their services -- physical and occupational therapists and speech-language pathologists, for example -- who were not able to before the pandemic.

"Specifically, federally qualified health centers and rural health clinics," Neufeld pointed out. "That was a big one that allowed a huge portion of the safety net providers in the country to bill Medicare for telehealth encounters."

By Liz Carey for The Daily Yonder.
Broadcast version by Mark Richardson for Michigan News Connection for the Daily Yonder-Public News Service Collaboration

In September, the Centers for Disease Control and Prevention (CDC) unveiled its Rural Public Health Strategic Plan, which outlines the priorities, objectives and outcomes the agency hopes to see over the next five years as it collaborates with other federal agencies and various stakeholders on how to improve the health of rural residents.

The plan was developed with the help of more than 50 experts within the CDC who reviewed more than 200 rural initiatives, programs and efforts to identify opportunities. Then the agency enlisted the feedback from more than 230 federal and external partners through listening sessions, lunch meetings and town hall events, Dr. Diane Hall, the director of the CDC’s Office of Rural Health (ORH), said in an interview with the Daily Yonder.

The strategic plan is a guide for ORH and the CDC at large, as it moves forward with programs and research into rural health needs. Developed with stakeholders such as the National Rural Health Association (NRHA) and state offices of rural health, the plan seeks to combat issues that are seen at higher levels in rural communities, like obesity, chronic illnesses and substance abuse.

Opened last year, the ORH came as a result of the Covid-19 pandemic. Disparities between urban and rural access to care shined a spotlight on the need for more attention on rural public health, she said. The strategic plan is the office’s first major publication.

“We really wanted the strategic plan to actually be strategic, but also be actionable,” Dr. Diane Hall, the director of the CDC’s Office of Rural Health, said in an interview with the Daily Yonder. “But more than that, we wanted it to be relevant to the lives of people that live in rural communities.”

Stakeholders, like Alan Morgan, CEO of the NRHA, said the plan is an indication of what is coming in rural health. 

“Realistically, this is a blueprint for the future,” Morgan said in an interview with the Daily Yonder. “They have highlighted long-standing issues and now they have a direction and a plan to get to where they need to be.”

The plan focuses on four main priorities – engaging with community health partners, strengthening rural public health infrastructure, advancing rural public health science and improving rural public health preparedness and response.

“CDC is committed to advancing rural public health across America by identifying and addressing gaps in the evidence base, data analytic capabilities, and the workforce in rural communities,” the plan said.

Hall said her office will work alongside stakeholders and other subject matter experts to develop a more specific action plan and to determine how best to serve rural areas.

“A lot of times, rural communities haven’t really been served well by government policies or decisions,” she said. “All of that needs to be addressed when we’re talking about health decisions.”

The plan isn’t regionally or state-specific, but it is a step toward an action plan, Hall said.

“Rural health is an issue that garners bipartisan support in Congress,” Hall said. “And Congress has been very clear that they wanted the CDC to create this office. These are the first steps in a very long process to address the rural urban disparities in healthcare.”

Hall said that before the end of the year, the National Center for Health Statistics (NCHS), part of the CDC, will release an updated method for urban-rural classification.

That will make researching rural health issues easier, Katy Backes Kozhimannil, the co-director of the University of Minnesota Rural Health Research Center, said in an interview with the Daily Yonder. One of the issues facing researchers is determining the rurality of subjects.

Although the strategic plan doesn’t provide direct actionable items, it is a step in the right direction, Kozhimannil said.

“This is a long process,” she said. “Working with local hospitals and rural public health agencies, as well as research centers like ours, is the beginning of the process. I think we’re all looking forward to the next steps and seeing what action items come out of this strategic plan.”


Liz Carey wrote this article for The Daily Yonder.


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Exposure to air pollution is a growing concern for public health and a breakthrough study from Wayne State University is shedding new light on its link to head and neck cancers.

In collaboration with Johns Hopkins University and Mass General Brigham, Wayne State researchers found fine particulate matter pollution known as PM2.5 may greatly increase the risk of cancers in the upper respiratory system. It is the tiny form of pollutants found in smoke, car exhaust and industrial emissions.

Dr. John Cramer, associate professor of otolaryngology at Wayne State University and the study's co-author, explained where the condition appears.

"Head and neck is actually very similar to lung cancer," Cramer explained. "These are cancers that typically occur in the lining of the mouth, the throat or the voice box."

According to the report, research on air pollution's effects on the lungs and heart is extensive but studies linking it to head and neck cancers are limited.

Dr. Cramer pointed out the tissue in the head and neck is especially vulnerable to air pollution because it comes into direct contact with the harmful particles. He emphasized there is a strong link between tobacco smoke and the most common type of head and neck cancer, squamous cell carcinoma.

How aggressive is it? Cramer stressed it is in the family of medium to highly aggressive cancers.

"Not the most aggressive cancer out there but it's also not one that is a total turtle of the cancer world," Cramer outlined. "I think it's a bit more of kind of a rabbit that can be a little bit sneaky and kind of get away."

He added the treatments for head and neck cancers, like radiation and surgery, are often intense and do not always succeed. He emphasized he would rather see fewer cases than treat them.

Medicaid renewals and steps the state is taking to improve maternal health are all topics experts will cover at the upcoming Kentucky Voices for Health annual meeting in Lexington on December 10.

Sessions count toward continuing-education requirements for the Commonwealth's Certified Community Health Workers and social workers.

Emily Beauregard, executive director of Kentucky Voices for Health, said The University o Kentucky's pharmacy team will be onsite - with a pop-up vaccine clinic for attendees and the general public.

"Everyone is welcome to come," said Beauregard. "It's going to be really convenient to have it right there. People can swing by for their seasonal boosters."

Attendees will also get the latest on initiatives to improve access to health care for students, incarcerated residents and individuals living with serious mental illness or substance-use disorder. More information is on the Kentucky Voices for Health website.

The state has made major strides in addressing maternal-health disparities among Black and brown Kentuckians.

Experts will break down the latest efforts to continue improving the health of moms and babies - including a special-coverage enrollment period for pregnancy, lactation supplies and consultation, a new helpline to support providers who are caring for new parents struggling with perinatal mood and anxiety disorders, and a newly commissioned study to look at the impact of doula care.

Beauregard said the upcoming legislative session offers opportunities to improve the health and lives of families.

"Policies that we expect to see, in terms of legislation in the coming session," said Beauregard, "will be paid parental leave for parents of new babies, and improving access to non-emergency medical transportation for Medicaid beneficiaries."

A 2023 state report found pregnancy-related-deaths in the Commonwealth went down in 2018 and 2019, but in 2020 increased to 21.2 deaths per 100,000 live births.

It's estimated more than 80% of pregnancy-related deaths are preventable.