RHAT: Fighting for Healthcare Close to Home

Everyone needs an advocate … someone who truly understands the unique issues you face and is willing to go to bat for you.

For healthcare providers and the citizens they serve in small towns all across the state, that ‘someone’ is the Rural Health Association of Tennessee.

Celebrating 20 years of service at the annual convention in Pigeon Forge this fall, RHAT is exclusively and specifically focused on Tennessee’s rural communities … advocating for and educating about all things healthcare. At the helm is Joellen Edwards, PhD, RN, FAAN, who serves as the 2014 president and was a member of the organization’s founding board.

As the association prepares to enter its third decade of service, the board is in the process of hiring RHAT’s first executive director. “We have had a wonderful executive assistant, Susan Veale, but she has been our only paid employee all these years,” said Edwards. After commissioning the Center for Nonprofit Management in Nashville to conduct an organizational assessment, RHAT decided the time was now to take the next step in growth.

“We have a wonderful advocate for our organization – Bill Dobbins,” Edwards noted of RHAT’s active lobbyist, “but we would also like to have an executive director to make sure the voice of rural health gets heard in all kinds of venues across the state, and we want to build our partnerships.” Edwards added RHAT also wishes to expand their educational offerings to rural healthcare providers and to identify additional grant writing possibilities.

The timing is right as the challenges facing rural health providers have only become more pronounced as community and critical access hospitals face uncertain futures in a changing healthcare environment. A handful of hospitals have closed over the past year (see related article on page xx) and a significant number of other facilities and services are so endangered that there is mounting concern over widespread access to care issues across the state.

Edwards, who is a professor and the associate dean for research at East Tennessee State University’s College of Nursing, said ensuring rural patients have access to providers was a main reason RHAT was so involved in a telehealth bill that passed this year. Introduced by RHAT and sponsored by Sen. Doug Overbey (R-Maryville) and Rep. Kelly Keisling (R-Byrdstown), SB2050/HB1895 codifies expectation of payment for services delivered via telemedicine communication tools.

“It fortunately passed, almost unanimously, requiring insurance companies to pay for telehealth visits,” said Edwards. She noted some payers already reimbursed for such services but the new law is meant to preserve access uniformly across the state no matter who carries coverage on the patient being seen.

Getting the bill passed and signed into law by the governor was only the first step, however. Edwards said the law is now in the rulemaking phase, and RHAT continues to be active and vigilant in ensuring the rules being developed don’t undermine the intent of the law. One concern, among several, is that individuals might be required to see a provider or specialist in a direct face-to-face meeting before being allowed to take advantage of telehealth technology.

“That might result in non-utilization, and i’s contradictory to the idea of telehealth,” Edwards pointed out. “We are absolutely dedicated to patient safety, but we do want the rules to be effective.”

RHAT Annual Conference

Twenty Years of Reaching for the Stars

November 19-21, 2014• Music Road Convention Center • Pigeon Forge, Tennessee

For registration and details, go online to rhat.org and click on the “Events” tab.

The association also closely monitored the recent legislation meant to curb methamphetamine production in Tennessee. Edwards readily admits it’s a balancing act between substance abuse and access to medications.

“Rural areas are primary sites for meth production. When you’re in an isolated area, it’s harder to discover,” she noted of meth labs. However, Tennessee’s natural beauty, which is so abundantly displayed in small towns across the state, also plays havoc with allergies and asthma. Edwards said it isn’t always as easy or cost efficient as lawmakers might believe to get a prescription. “We’re not promoting drug use by any means, but to us, it’s an access issue,” she said, adding the compromise legislation that passed wasn’t “as bad as it could have been … kind of a lukewarm victory.”

RHAT is also working to increase access to oral health through a resource directory outlining providers that will see patients without dental insurance. A pilot program in the eastern part of the state has worked well, but now RHAT would like to expand the reach statewide.

Similarly, Edwards hopes to see expanded behavioral health services to areas lacking population density. “In terms of access, you’re not going to find mental health providers in rural areas at nearly the level you will in urban areas,” she stated. She is particularly excited about a relatively new program at ETSU that offers a doctorate in psychology with a specific rural focus.

A Mountain City rural clinic staffed by ETSU’s College of Nursing utilizes the psychology students, supervised by clinical faculty, through telehealth and onsite clinical rotations to address mental health needs. Edwards said the integrated program has worked wonderfully well … providing convenience to those already coming to the primary care center and taking away some of the stigma of accessing behavioral health services.

As always, almost every area of focus for RHAT circles back to access. “We are the organization that started the Tennessee Rural Partnership, which is now housed inside the THA,” she said. The partnership, originally set up specifically for physicians, now extends to nurse practitioners and physician assistants interested in working in rural settings. “It’s been very successful. They have matched up many, many physicians and providers with the communities that need them,” she noted.

Although there are many obstacles providers face in delivering quality care to rural areas, Edwards said there are also many rewards.

“If you’re practicing in a smaller community, you have fewer patients … which can compromise your finances … but you really get to know your patients. There’s a lot of joy in that,” she concluded.



Tennessee Dept. of Health, Office of Rural Health