cancer, telehealth, disparities, rural health, policy


Background: In the United States, 6 of the 25 leading causes of death stem from site-specific cancers, resulting in over 1.7 million deaths annually. Yet, this burden is not evenly distributed. While the incidence of cancer is significantly higher in urban areas, rural regions face higher rates of cancer mortality. Identifying the factors contributing rural cancer disparities can facilitate more effective and feasible policy solutions.’

Problem Definition: Rural Americans are geographically isolated from high-quality cancer services and face systemic barriers to NCI designated comprehensive cancer centers. Given this disparity, rural Americans have failed to fully realize the benefits of expanded federal investment in improved cancer care. Efforts to increase the supply of rural oncologists have yielded mixed results. Rather, this policy review identifies an opportunity to expand the capacity of America’s oncologists through provider-to-provider telehealth models.

Methods: Federal and state statutes were scanned for telehealth legislation. CMS guidance relating to telehealth capacity building were also reviewed. The tabulated political venues and policy activity were reported by branch and level of government. Policy recommendations were then made by the focusing on states implementing provider-to-provider teleoncology models in rural regions.

Policy Report: In 2016, Congress passed the Project ECHO Act which aimed to evaluate all provider-to-provider telehealth capacity building models. However, the 2019 Project ECHO Act, which aimed to build upon the initial pilot, failed to progress through the Senate. Most provider-to-provider teleoncology activity occurred at the state-level through Medicaid Waivers.

Conclusion: Neighboring states can build upon the success of these innovative healthcare delivery models by expanding the diffusion of Medicaid waiver demonstrations which authorize reimbursement for provider-to-provider teleoncology in rural areas.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.