Between 2011 and 2017, both median overall profit margins and the proportions of profitable rural hospitals declined. This is a stark contrast to the improving financial conditions of urban hospitals during this same time. To make things worse, the COVID-19 pandemic has amplified existing financial pressures twofold on rural hospitals. The CARES act and other pieces of legislation have alleviated some of this pressure in the short run, but long run solutions will need to be implemented when the pandemic ends. Expanding eligibility for Medicaid and making explicit payments to cover the costs of standby services in rural hospitals are a few ways rural healthcare can begin to operate at a financial gain.

Telehealth is now being used much more widely to screen and diagnose patients without risking exposure to the virus. As many as 93 percent of patients who have used telehealth during the COVID-19 pandemic agreed that telehealth improved patients’ access to care. However, the majority of people that these services would be most useful to still lack access to basic infrastructure that could facilitate a virtual visit. Additionally, laws are still in place that restrict reimbursement of telehealth visits to people that meet certain criterion. As the COVID-19 pandemic fades in severity, health care providers face challenges in the implementation of permanent telehealth services for their patients.

On July 2, Senators Bill Cassidy and Tina Smith wrote to the HHS Secretary and CMS Administrator urging them to be transparent in their future plans for telehealth. The letter was supported by 38 senators in total as they advocate on behalf of their rural communities. This letter addressed the fears of Medicare patients that temporary changes to telehealth coverage will be rolled back without notice after the COVID-19 pandemic.

The AMA, along with more than 70 health care organizations, are urging congressional leaders to, “Prevent the sudden unavailability of virtual health options for Medicare patients” after the national public health emergency has ended. Key parts of the first three COVID-19 relief packages expanded telehealth services to a broader scope of Medicare patients, especially in rural areas. However, this expanded coverage is only temporary and will expire at the end of the public health emergency period. In their letter to Congress, these health care associations are urging leaders to act now before coverage and payment for telehealth services end for seniors outside rural areas and to the home.

A bipartisan group of 38 senators released an open letter asking leaders to provide a written plan for permanent changes to rules surrounding telehealth. Telehealth has expanded tremendously amid the COVID-19 pandemic and has shown both patients and providers how valuable it can be. Relaxed regulations on Medicare and Medicaid from the HHS has boosted this expansion. However, many are worried about when these temporary changes to telehealth rules will be rolled back and whether they will receive any advance notice. Senators are urging the Administration to consider how permanent changes to telehealth can be part of a beneficial shift toward value-based care.

Echoing the concerns surrounding the effects of the COVID-19 pandemic on rural America, U.S. Senator Joe Manchin (D-WV) questioned HHS and CDC officials on Operation Warp Speed. This operation oversees the research, creation, and production of a potential COVID-19 vaccine and the plans for future distribution. West Virginia, a hotspot for recent rural COVID-19 infections, will need quick and effective distribution of the vaccine when it is ready. Manchin made clear that the HHS and CDC must ensure rural providers have the necessary equipment and personnel to administer the vaccine.

Senator Martha McSally (R-AZ) and 48 other Members of Congress are asking the U.S. Department of Health and Human Services (HHS) to provide relief quickly to rural health care providers affected by the COVID-19 pandemic. In their letter to Congress, Members cited the spike of COVID-19 cases in recent weeks and the increasing rate of infections across rural America. Infections are growing 13 percent faster in rural areas compared to 9 percent nationally, all the while rural hospitals continue to close. Before the crisis worsens, they are calling on Congress for relief through metrics such as a 20 percent Rural Benchmark in the Provider Relief Fund. Additionally, priority should be given to populations in areas with limited access to health infrastructure and high levels of uninsured patients.