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Open Spaces

COVID-19 Puts Rural Telehealth On The Fast Track

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Kamila Kudelska
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Ron sitting where he has his telehealth sessions.

Early one morning, U.S. National Guard veteran Ron Loporto sat down on his exercise ball in front of a laptop to log into his telehealth session. He has been doing this weekly for the past month or so.

"Good morning," Loporto said when a face appeared on his laptop. A garbled sound came out of the computer.

"I'm having trouble hearing you right now," Loporto said. "Can you hear me?" He turned towards me, "For some reason, this is the first time I've ever had static."

After a couple more moments of trying to figure out what's wrong, they decided to use the phone to hear each other but stayed on video so that they could still see each other. "Sure, sure. I can see you and I can hear you fine over the phone."

When I met back up with Loporto after he finished his session, he said this was the first time he's encountered technical problems. Loporto has been using telehealth for his sessions since March when the Sheridan VA announced it was closing its doors to the public due to COVID-19.

Technical glitches and just not being able to get the same results was some of the things Ron was originally worried about when he couldn't go into the office for his appointments.

"But my psychologist, again, she called me and she said, 'You can't come to the office. We'd like you to try this VVC VA Video Connect. I said, 'I really don't want to sit in front of the computer for an hour. It's just not my thing.'"

But he realized it probably would be better to still have some kind of sessions with his psychologist versus the possibility of his episodes coming back, a symptom of his Post Traumatic Stress Disorder.

It turned out Loporto's provider was herself a reluctant telehealth convert. Robin Lipke is a clinical psychologist in the outpatient mental health clinic at the Sheridan VA Medical Center. She has done telehealth in the past, but it was always done with an intermediary. This means an individual arrived at a clinic somewhere in Wyoming, was checked in by a nurse and then would enter a room where there was a screen that Lipke would appear on. For Lipke, the second set of eyes was important.

But she said the COVID-19 pandemic really made her realize telehealth was the best alternative, especially when she started to notice that patients started opening up a different way at home.

"As we were talking, they might say, 'Oh, you see this photograph back here?'," said Lipke. "And might start talking about something that I might not have gotten if we were only in the office."

It turns out telehealth is the solution to a number of issues beyond mental health.

For years, it's been very difficult to get mental health services to rural places like Wyoming and its small communities. A big part of the issue is the lack of mental health providers and that people frequently would have to drive over an hour for such services.

Alan Morgan, the non-profit National Rural Health Association CEO, said the long distances between small towns to larger areas limit access to health care.

"The real concern is you just can't get specialty care to live and work in a rural community," he said. "And telehealth has the potential to bridge this."

Morgan said everyone is discovering that telehealth can address most concerns.

"We need to start realizing that you've got telebehavioral health, you got telepharmacy, you got teleradiology, telecardiology. All these have different roles and different applications and they really need to be thought of separately," said Morgan. "Telehealth is a tool. And that's the best way to look at it. It's a tool for expanding access to care."

But this tool received lots of pushback for many reasons like money, insurance coverage, stigma and regulations. But when COVID-19 hit, everything opened up. As healthcare facilities and hospitals had to close their doors for non-essential services, people in charge realized telehealth may be their only option to continue taking care of people like Loporto who can't have a gap in their care.

"You cannot overstate the dramatic impact that COVID has had on access to care in relations to telehealth," said Morgan. "Once federal and state officials removed many of the regulatory barriers prohibiting that and provided funding for Medicare and Medicaid for these telehealth services, it really opened the opportunity to enhance health care in a rural setting."

Morgan said the impact has already been seen, and this is evidenced by policymakers in D.C. and at state levels indicating they have no intention of going back.

"I think that we are now locked into a new paradigm of how we deliver health care in a rural setting," he said.

During the pandemic, telehealth appointments including mental health and primary care. increased by over 1,000 percent. And the VA as well as other healthcare institutions don't want to stop this momentum as they believe it will help them provide better care for their patients in rural places.

This story is adapted from an episode of The Modern West podcast as part of its series on ghost towns, both past and in the making. Subscribe wherever you get podcasts.

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