Tucson Q&A with Alison Hughes

T Q&A 

Alison Hughes says she's been on a mission for the past two decades to reduce health inequities in the state's remote areas. On July 1, she stepped down as director of the UA's Rural Health Office after four years to free herself of administrative duties, allowing her once again to concentrate on the programs that are the lifeblood of her crusade. A focus of her directorship was bringing to rural communities the benefits of telemedicine, which is providing health care at a distance using telecommunications technologies. The Weekly recently sat down with Hughes at her home in Tucson.

Why is rural health so important to you?

For many years, there has not been an equitable distribution of the nation's resources to enable people who live in rural areas of the United States to get health care. It's a matter of equity. It's a matter of equalizing resources, so that rural residents--frontier residents--get the same health care as people who choose to live in urban, suburban, exurban areas.

In the past five or six years, two rural hospitals, in Florence and Holbrook, closed. Why?

Financial (reasons). The reimbursement system for rural hospitals was inequitable. ... The urban hospitals were getting larger reimbursements in their costs for care. If it's based on the same formula, which it was, then rural hospitals are going to get less, because they have lower volume.

Has anything been done to change that system?

The federal government started a new program called the Rural Hospital Flexibility Program that was to help hospitals get a new designation. ... There were certain criteria the hospitals had to meet. In exchange, they would get cost reimbursement. With cost reimbursement, they would get back what it cost them to provide services. ... We set to work and helped 12 hospitals get the designation.

In what other ways is rural health care not equitable?

I can give you many examples. Let's take modern health care: There's a movement now to bring telemedicine throughout the country. That same movement has now been articulated by the president, who wants electronic health records throughout the country. This is an amazingly huge undertaking. You live in an urban community--so do I. We're used to the Internet. ... In rural communities, they don't have access to high-speed lines to allow them that sort of thing (electronic health records). ... Besides which, the federal policies that affect reimbursement for telemedicine consultations are inequitable.

How do the consultation reimbursements work?

Say you have a heart problem, and you're in a rural area, and your doctor wants you to meet with a cardiologist. So your doctor arranges for a (telemedicine) meeting with the cardiologist in an urban area. The cardiologist can listen to the heart, can listen to the vital signs ... and can recommend whether or not you need to come in for special care or need to be hospitalized, or whether the treatment can be applied in the remote area. But the doctor in the rural area takes the time to be with the patient for that consult. If it's a Medicare patient or whatever, then the rural doctor gets no payment for that.

What are some other impediments to getting telemedicine in rural areas?

You go out to, for example, Safford. You'd find telecommunications problems out there. Through the telemedicine program that I have an affiliation with, we put some equipment in Safford to try home-health care applications. Then there was a thunder storm, and the whole phone system went out. The telecommunications policy is that all the phone companies have to do is make sure they have telephone access in rural areas. ... So if a community wants to have, say, broadband, then it costs extra money.

And many rural communities don't have the funds for that--right?

There's an inequity in the distribution, because, obviously, the financial resources of the country are focused in urban areas and not in rural areas. But we need people in rural areas; they produce the food that keeps us living in urban areas. So they deserve to have the same access as everyone else.

What can be done to bring telemedicine to rural areas?

We need to have more resources put into broadband grants, rather than loans. We need people to understand more about the implications about what this can do for their lives. Granted, there are some rural people who say, "Leave all this technology alone. We don't want it." That's fine; we respect that. But their kids can be quite different. They've got television, and the kids are looking at TV programs, and they want more. ... People want more. They want what Americans have.

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