Sustainability Strategies for Rural Telehealth Programs
There are several different strategies for sustaining telehealth programs that may be useful for rural
healthcare systems and providers. The Rural Community Health Toolkit also provides information about general Sustainability Strategies and Sustainability Strategies for Specific Issues.
Additional information about funding for rural telehealth projects and systems can be found in the Telehealth Use in Rural Healthcare topic guide.
Reimbursement for Telehealth Services
The Center for Connected Health Policy monitors the
latest policies related to reimbursement rates for telehealth for Medicare, Medicaid, and private
The Health Resources and Services Administration's Medicare
Telehealth Payment Eligibility Analyzer tool can also help communities determine their eligibility for
Medicare reimbursements. CMS
provides guidance to clarify reimbursement policies for Medicare fee-for-service providers. CMS also
developed a booklet called Rural
Providers and Suppliers Billing.
When planning for long-term sustainability, rural communities should be aware of the following considerations
Parity laws at the federal and state level determine
whether telehealth visits are reimbursed at the same rate as in-person visits.
Payers may also limit reimbursements for certain telehealth applications. For example, some payers may only
reimburse live-video telehealth consultations, while others may also fund store-and-forward and remote
patient monitoring services.
Reimbursement restrictions on provider type also vary from state to state. Eligible providers may include
physicians, advanced practice clinicians, and other licensed healthcare workers.
Value-Based Payment Mechanisms
Some rural communities are financing
telehealth programs through value-based payment mechanisms, such as accountable care organizations
(ACOs), that value quality over volume of care. These programs seek to use telehealth to achieve quality,
outcome, and cost targets, including reductions in hospital readmissions, lengths of stay, and transfers to
larger care centers. For example, Oregon's Coordinated Care
Organizations (CCOs) receive global budgets to integrate physical, behavioral, and dental healthcare for
members. CCOs have invested
in several telehealth initiatives to improve the health of Oregonians, including telemental health
services, remote patient monitoring, and telementoring.
During the COVID-19 pandemic, some health care organizations were able to use the
flexibility of value-based payment structures to quickly meet the needs of their patient population with
Telehealth User Fees
A key feature of telehealth is connecting rural sites to remote providers and specialists. Some rural sites
contract directly with a remote provider who can offer telehealth services. Other rural programs pay user fees
to subscribe to a telehealth center, which is typically located in a larger hospital or academic medical center.
The fees to connect to these telehealth services can strain facilities with limited budgets. Considerations for
rural programs seeking to make the case for investing in telehealth user fees include:
Staffing flexibility – Telehealth allows some rural facilities to implement less
expensive or more feasible staffing models. For example, some Critical Access Hospitals may have difficulty
recruiting qualified physicians to staff emergency departments in rural locations. These hospitals may
choose to instead recruit advanced practice nurses to staff emergency departments while using telehealth to
enable access to remote case consultations and telementoring.
Return on investment – Rural communities can consider if the return on investment
from telehealth services justifies the cost of paying for consulting fees. Factors that may affect return on
investment include increased revenue from keeping patients in the community and billing for encounters.
Programs may also consider cost reductions associated with traveling for professional development and
conducting recruitment activities.
Alignment with mission of the facility or organization – Some rural programs may
consider how telehealth allows them to work towards the mission or vision of their organization by improving
quality of care, access to care, health outcomes, or patient satisfaction.
Working with Payers and Policymakers
Some rural communities may choose to work directly with policymakers, Medicaid officials, and private insurers
to make changes to reimbursement policies and achieve long-term sustainability for their telehealth programs.
Rural programs may consider approaching insurers to determine if they can use telehealth to achieve shared goals
for improving outcomes and decreasing costs. For example, a private health plan interested in reducing
diabetes-related hospitalizations might be willing to fund a remote patient monitoring program to improve
Rural programs may need to build relationships with state medical and pharmacy boards in order to address
additional factors that affect telehealth sustainability, including regulations for licensure and certification.
Rural programs may also consider joining or establishing coalitions in order to mobilize diverse stakeholders to
support telehealth policies.
Resources to Learn More
CCHP Policy Finder
An overview of the status of state telehealth policies in the U.S. Primary topics covered include Medicaid
reimbursement, private payer regulations, and professional requirements.
Organization(s): Center for Connected Health Policy (CCHP)
Facilitating Telemedicine Project Sustainability
in Medically Underserved Areas: A Healthcare Provider Participant Perspective
Describes factors affecting the long-term sustainability of teleconsultation projects from the perspective of
providers, and how project design can address these factors. Data was collected from interviews with clinicians,
administrators, and information technology professionals working in fourteen telemedicine projects within two
Author(s): Paul, D.L. & McDaniel Jr., R.R.
Citation: BMC Health Services Research, 16, 148
Review Of Quality Metrics And Reimbursement For Telehealth
Presents an overview of quality metrics and reimbursement strategies supporting the expansion and maintenance of
telehealth programs. Identifies methods to design quality metrics, demonstrates how to use quality and revenue
data to support telehealth programs, and highlights reimbursement strategies to promote growth.
Author(s): Hager, M.
Organization(s): Upper Midwest Telehealth Resource Center, National Consortium of Telehealth Resource Centers
Telehealth Laws & Reimbursement Policies – State Summary Chart
A chart highlighting key telehealth policies by state. Categories include Medicaid reimbursement, private payer
reimbursement laws, and professional requirements including interstate compacts and consent.
Organization(s): Center for Connected Health Policy (CCHP)
Essentials For FQHCs And RHCs
Provides suggestions for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to maximize
their resources to promote remote healthcare delivery. Helps FQHCs and RHCs learn from other telehealth programs
and be aware of the important changes needed to support sustainability
Organization(s): Southwest Telehealth Resource Center (SWTRC), National Consortium of Telehealth Resource
Implementation Model (TSIM™): A Framework for Telehealth Service Development, Implementation, and
Describes the Telehealth Service Implementation Model (TSIM), a framework supporting providers and health
systems in their development and implementation of telehealth services. Defines a phased approach in four
stages: strategy, development, implementation, and operations, and concludes with quality improvement.
Organization(s): Medical University of South Carolina (MUSC) Telehealth Center of Excellence
Toolkit for Building and Growing a Sustainable Telehealth Program in Your Practice
Provides a comprehensive approach for family medicine practices as they progress through the telehealth process.
Reviews telehealth services and payment options, considerations for achieving sustainability, and offers a
variety of scenarios for implementing telehealth into family practice.
Organization(s): American Academy of Family Physicians (AAFP), Manatt Health