RTC:Rural Encourages Public Comment on Rural Telehealth and Healthcare Systems Readiness Measurement Framework

October 21, 2021

The public is invited to attend a web-meeting on Monday, October 25, 2021 from 3:00-5:00 ET regarding a proposed framework for measuring Rural Telehealth and Healthcare Systems Readiness.  RTC:Rural encourages rural disability stakeholders to attend the meeting where the National Quality Forum will review public comments, as well as finalize additional modifications to the framework.

The agenda and meeting materials, including dial-in information, will be posted to the project page once they are available.

As leaders in rural disability research, RTC:Rural provided expert comment on the proposed framework. Those comments as well as additional information about the Rural Telehealth and Healthcare Systems Readiness project are available for further review below.

The 2019 COVID pandemic impacted healthcare access and delivery to community members across the country. As a result, the use of telehealth significantly increased, including in rural America. What is not yet fully known is the quality of care provided via telehealth services, which is particularly important for rural areas that experience unique barriers and risks for residents seeking positive health outcomes.

The National Quality Forum (NQF) completed an environmental scan and convened a stakeholder Committee as part of a project funded by the Centers for Medicare & Medicaid Services (CMS) to present a proposed measurement framework that links the quality of care provided by telehealth, healthcare system readiness, and rural health outcomes in a public emergency, such as natural disaster, mass violence, and most recently notable, a pandemic. 

 NQF requested comment on its proposed framework in five different domains:

  • Access to Care and Technology: the ability of telehealth to increase rural patients’ access to certain types of healthcare during emergencies
  • Costs, Business Models, and Logistics: the costs of using telehealth, how it is supported financially, and delivery model implications
  • Experience: how interactions of patients/caregivers and care team members through telehealth meet their needs and preferences
  • Effectiveness: the desired outcomes, safety, and timeliness of care delivered via telehealth
  • Equity: how telehealth can help support equal opportunities for all people to be healthy

RTC:Rural submitted comment and considerations to improve the framework in the contexts of equity, access, and community infrastructure, with a statement of support from the American Association on Health and Disability (AAHD) and the Lakeshore Foundation. These comments include:

  1. There appeared to be a lack of committee representation from key rural community and community living agencies or stakeholders. 17 % of rural community members have a disability and folks with disability experience from a rural perspective should be engaged with NQF panels on this topic.
  2. Measurement tools lacked specificity regarding user experiences related to accessibility. Planning for accessibility and inclusion of people with disability cannot be phased in later, but should be a component of the planning and analysis work.
  3. Measures appear to target those receiving services, and don’t fully assess those who do not. Although the framework acknowledges disparities in health and technology literacy, as well as other dimensions of user experiences, it doesn’t fully capture those who lack technology and would likely not be served in an emergency situation.
  4. Community level indicators are vital to understanding both the positive and negative impacts of emergency-driven telehealth. While the framework highlights these benefits of telehealth in terms of increased access to timely care and specialists, and decreased barriers in terms of transportation, it lacks significant inquiry into the risks of lost community capacity to serve people in-person. A more balanced assessment of this risk is warranted.

RTC:Rural sincerely appreciates NQF efforts to fully assess the impacts of telehealth in rural communities.