• Lori Uscher-Pines, Jessica L Sousa, Kori S Zachrison, Lee Schwamm, and Ateev Mehrotra.
• RAND Corporation, 1200 S Hayes St, Arlington, VA 22202. Email: luscherp@rand.org.
• Am J Manag Care. 2022 Dec 1; 28 (12): e436e443e436-e443.

ObjectivesTo explore the perceived impacts of a variety of telehealth services on hospital finances and assess how hospital administrators make decisions about adopting telehealth programs.Study DesignFrom October 2021 to January 2022, we conducted semistructured interviews with chief financial officers (CFOs) of rural hospitals.MethodsRecruitment occurred in collaboration with 6 rural health collaboratives and hospital associations that facilitated CFO peer-learning groups. We used inductive and deductive approaches informed by a health care innovation adoption model to identify themes in the qualitative data.ResultsTwenty rural hospital CFOs and other hospital administrators from 10 states participated in interviews. Seventeen (85%) represented critical access hospitals and 3 (15%) represented short-term acute care hospitals. Although CFOs believed telehealth has some financial advantages (eg, can help to avoid patient transfers), they did not believe that telehealth improved their hospitals' financial situations. CFOs, rather, seem motivated to implement telehealth services to improve quality of care and address patients' needs. CFOs reported that limited reimbursement, low volumes, preference for in-person care, and insufficient broadband were key challenges to telehealth's financial viability.ConclusionsUnderstanding how CFOs think about the return on investment of telehealth can inform efforts to promote telehealth utilization in rural communities and to develop policy solutions to make telehealth more sustainable. CFOs may benefit from guidance on promising practices and cost-effective implementation strategies. Policy makers could take steps to improve telehealth's financial attractiveness (eg, through payment parity, subsidies to improve technology infrastructure).

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