How to Improve Rural Access to Maternity Care with Telemedicine
Telemedicine Helps Bridge the Gap Between High-Risk Pregnancies and MFM Specialists
More than 700 women in the United States die each year due to pregnancy-related complications. It is estimated 3/5 of those deaths are preventable. The key to prevention? Access to high quality perinatal care. The problem? The U.S. currently faces a shortage of 8,000 OB-GYN physicians. By 2050, the OB-GYN shortage is expected to climb to 22,000. Not only that, 10 million U.S. women live in rural areas must travel significant distances to access care. Fortunately, there are a growing number of obstetrics telemedicine options available to connect high-risk pregnancies and leading specialists.
Why are rural communities especially vulnerable?
Less than ½ of the 10 million women living in rural communities live within a 30-minute drive of the nearest hospital offering perinatal services. Adding to the need, rural areas are associated with higher rates of diabetes, hypertension, and obesity, all of which are associated with high-risk pregnancies. A recent study found that rural residents have a 9% greater likelihood of severe maternal morbidity/mortality than their urban counterparts. Contributing factors include both clinical (shortage of physicians and specialists, low patient volume, and the opioid epidemic) and social challenges (transportation, housing, poverty, food security, racism, violence, and trauma).
“More than 50% of all babies are born in hospitals where fewer than 1,000 deliveries are performed, and almost 40% are born in hospitals where fewer than 500 are performed. To provide high-level care and have patients feel comfortable, to improve morbidity and mortality, we need telehealth and telemedicine.”
Haywood Brown, MD, 2017-2018 ACOG president and current Professor of Obstetrics and Gynocology at Duke University in Practice Management magazine
How can telemedicine help?
The American College of Obstetricians and Gynecologists recently endorsed telemedicine to improve maternal morbidity and mortality and enhance current methods of care. Telemedicine presents the possibility of connecting a growing number of high-risk pregnant patients with convenient access to specialist medical consultation. Smaller healthcare facilities in rural areas often lack the resources to hire high-cost MFM specialists to provide care for high-risk conditions such as preeclampsia, prematurity risk, and others. Telemedicine offers a lower cost alternative to offer MFM specialist care without significant patient or provider travel.
Telemedicine can be leveraged to deliver both prenatal and postnatal services. During the prenatal period telemedicine applications include:
· video conferencing and live ultrasound streaming to replace in-person visits
· at-home monitoring of weight, blood pressure, fetal heart rate, and blood sugar, etc.
· remote consultation with MFM specialists
During the postpartum period applications include virtual:
· follow-up visits
· mental health care
· lactation support
Though technologies are still emerging and rural facilities face challenges such as start-up costs, limited internet access, and inconsistent Medicaid and commercial insurance reimbursement for telemedicine services across states, telemedicine is changing the way rural facilities can care for pregnant patients. As more and more specialists, clinics, and hospitals implement telemedicine, rural access to specialty MFM care is expected to increase. This expanded access is expected to lead to improved patient experience, expanded income sources for rural health clinics, and improved maternal and infant outcomes over time.
Virtual Perinatal Care and COVID-19
Due to the COVID-19 Public Health Emergency, Medicare has temporarily expanded its coverage of telehealth services. These loosened restrictions make this a prime time to begin leveraging telemedicine to help pregnant moms get the specialist care they need without having to travel and risk unnecessary exposure to COVID-19.
Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will:
Waive originating site restrictions, meaning patients can receive telehealth services in their homes and other non-clinical settings;
Allow use of smart phones that have audio and video capabilities;
Allow reimbursement for any telehealth covered code, even if unrelated to COV-19 diagnosis, screening, or treatment; and not enforce the requirement that patients see a provider within the last three years.
We suggest consulting the following resources as you make your COVID-19 telehealth plan:
About Perinatal Access
Perinatal Access is a cloud-based digital health platform that is changing the way perinatal care is delivered. It leverages telemedicine and live ultrasound streaming to enable OB/GYN physicians and other specialists in the Obstetric space (Maternal Fetal Medicine, Pediatric Cardiology, etc.) to be more effective. Perinatal Access enables video visits between a remote physician and patient at another clinic or hospital. It gives the remote physician the ability to see a real-time stream of the patient’s ultrasound. In the past, physicians had to be in the room during an ultrasound. With Perinatal Access, physicians can be down the road or across the country and interact with the patient and the ultrasound in real-time from their iPad or iPhone. For more information visit perinatalaccess.com or call 214-796-0303.