Millionaire country music stars like to pretend they spend their weekdays driving a tractor and their weekends driving pretty girls down dirt roads in their pickup truck. While they can only dream, many Mississippians live the true country life in all its glory. It is a good life, but not as simple as the performers portray it to be. Living far away from population centers can mean reduced access to many essential services, like healthcare. Maintaining access to rural emergency medicine could be the difference between life and death for many Mississippians.
In Mississippi, there are 64.4 primary care physicians for every 100,000 residents, far below the national median of 90.8. Half of the Mississippi’s rural hospitals are in financial risk. Some have closed down completely, or shuttered critical services such as emergency rooms.
Rural emergency rooms are difficult to maintain. They must stay open 24 hours a day, seven days a week. The hospital has to hire several emergency room physicians to take turns covering those shifts. If those staff physicians cannot cover a shift, the hospital has to bring in a temporary physician – often from out of state. Not only is it expensive to staff an emergency room, it can be hard to recruit multiple emergency medicine physicians to live and work in a small town. Moreover, if a rural hospital does succeed in staffing an emergency department, it will see relatively few patients. Rather than bringing additional income to the hospital, it will likely cost the hospital money to operate.
Emergency telemedicine allows some small hospitals to keep their emergency rooms open, by staffing them with physician assistants and advanced practice registered nurses. When a patient arrives, an emergency medicine physician in another location – often a larger hospital – uses audio/visual technology and remote diagnostic tools to see the patient, and to instruct the nurse or physician’s assistant on the care that is needed. Some small hospitals choose to keep a physician in the emergency room, but use emergency telemedicine to provide an additional layer of expertise and consultation for their emergency department patients.
Despite the clear benefits of emergency telemedicine, its use in Mississippi has been limited. Current regulations prohibit physicians from providing emergency telemedicine services to small hospitals unless they worked at a Level One Hospital Trauma Center with helicopter support. Mississippi only has one Level One hospital in the state, so there has been no competition for this service. However, any physician who is board certified in emergency medicine is capable of providing emergency telemedicine services, and is able to transfer a patient by helicopter, regardless of the type of hospital the physician works for.
In short, the current regulations do not make sense, and prevent new providers from offering more options for emergency telemedicine. They are also vulnerable to a legal challenge, as they likely violate the due process and equal protection guarantees of the Mississippi and U.S. constitutions, and may violate federal antitrust laws.
One telemedicine provider that has been locked out of the emergency care market is T1 Telehealth located in Canton, Mississippi. T1 Telehealth was the state’s first private telemedicine company, and it developed a new model for emergency telemedicine that it believed would provide a better service for rural hospitals and patients. But it could not offer that new model due to the regulatory restrictions.
T1 Telehealth retained the Mississippi Justice Institute – a nonprofit constitutional litigation center that I work for – to challenge the emergency telemedicine regulations. After months of input and discussions with T1 Telehealth and other stakeholders, the Mississippi State Board of Medical Licensure has taken the right approach to make the regulations fair and to increase access to healthcare. New proposed regulations have been adopted that will allow any licensed emergency medicine physician to offer emergency telemedicine services in Mississippi.
The new proposed regulations will be reviewed by the Occupational Licensing Review Commission before becoming final. Approval by the commission seems assured, as it is chaired by Gov. Phil Bryant, who has been a tireless champion of expanding telemedicine in Mississippi and a strong supporter of efforts to reform the state’s anticompetitive emergency telemedicine regulations.
The new regulations will be a great development, not just for T1 Telehealth, but for all telemedicine providers, for small rural hospitals that rely on telemedicine, and for patients across Mississippi. Competition encourages innovation, more options, better services, and lower prices. All things that will make rural healthcare and Mississippi country living that much better.
This column appeared in the Clarion Ledger on May 29, 2019.