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Adapting to Survive the Pandemic and Beyond in Rural California

By Topic: Delivery of Care Rural Value-Based Care Reimbursement


How has COVID-19 affected your organization? 
We rely on volume- and value-based payments, and our outpatient volume has dropped 30% since March due to COVID-19. Rural health systems traditionally have fewer resources, and  given the added strain of the pandemic, we had to strategically adapt to the new environment to survive. This meant downsizing some departments and restructuring others. With the help of the coronavirus rescue package, we were able to offset revenue losses. Operationally, we changed our work and clinical flow to cater to our community's current needs. For example, we began delivering medication and food to patients. 

How has your organization responded to this unprecedented crisis? 
Since our clinics are located in rural towns, we initially provided testing and screening in mobile vans. We also began using telehealth for primary and mental healthcare and e-consults for specialty care. We used telehealth to screen patients for COVID-19 while keeping our staff and patients safe. We performed over 200 screenings weekly during April and May in remote towns that are federally designated as health provider shortage areas and provided telehealth support groups to help people cope with the coronavirus. Telehealth enabled us to manage the care of patients with chronic disease, such as diabetes and hypertension, preventing them from going to the ED at a time when the risk of infection from COVID-19 was high. The Centers for Medicare & Medicaid Services’ new rules regarding billing for telehealth helped us continue providing care during this difficult time. 

What role will telehealth play in your organization moving forward? 
I hope the federal government will continue supporting virtual patient visits by allowing comprehensive reimbursement beyond COVID-19. This is vital for the survival of rural health systems. I anticipate telehealth will enhance patient-centered care by adding value and ease for patients who live in remote places where access to care is limited. To continue providing these virtual services to underserved patients and billing for them will require finding the right balance between patient volume, value and revenue. Such balance is crucial to continue providing care to patients who face significant health and socioeconomic disparities, such as limited access to care, and are covered by government payers or are uninsured. Telehealth and e-consults allow us to streamline care and overcome barriers while contributing to a sound financial bottom line. 

How has ACHE contributed to your ability to lead, especially during a crisis? 
I have attended many webinars and online seminars during the last few months on the use of telehealth and regulations and strategies for organizations to implement in response to COVID-19. Through ACHE, I have benefited from the shared knowledge of its member community, which I apply to our organization to continue providing health services for the rural communities  we serve. 

Miku Sodhi, MD, FACMPE, is deputy CEO at Shasta Cascade Health Centers, a federally qualified health system in McCloud, Calif., and an ACHE member (miku_sodhi@hotmail.com).