EDITORIAL: Rep. Kim Schofield: Georgia Has the Opportunity to Become the National Model for Rural Lupus Care

By State Representative Kim Schofield (D-Atlanta)

(945 words)

For a Georgian living with lupus, the difference between managing the disease and reaching a medical crisis can come down to something as basic as a zip code.

That should be unacceptable in a state with some of the nation's leading healthcare institutions, growing telehealth capacity and now more than $218 million in first-year federal Rural Health Transformation funding.

Georgia has an extraordinary opportunity before us. We should use it to make a commitment that extends beyond installing technology or expanding broadband connections. Georgia should become the national model for rural, technology-enabled lupus care.

The federal Rural Health Transformation Program is providing Georgia with resources to strengthen rural hospitals, grow the healthcare workforce and expand technology-enabled access to care. The latest $93.3 million investment completes Georgia's initial Year 1 funding cycle and includes support for telehealth, care networks and other technologies intended to bring healthcare closer to rural patients. That investment deserves recognition. But investment alone is not transformation. Transformation happens when technology reaches the patient who needs the specialist.

Georgia law has long recognized that as many as 55,000 Georgians may be living with lupus, a complex autoimmune disease that can damage the kidneys, heart, lungs, nervous system and other organs. Lupus often requires continuing care from a rheumatologist, along with primary care, and depending on the patient, nephrology, dermatology, cardiology, behavioral health, maternal health and other specialties. Yet geography remains a significant barrier to specialty care.

National research examining lupus in rural Georgia has highlighted the problem: 84 percent of rural areas nationally lack a practicing rheumatologist, and some people with lupus in rural communities may travel 75 to 200 miles for clinical care.

Think about what that means for a patient already managing fatigue, pain, medication side effects, work, family responsibilities and an unpredictable chronic disease.

A specialist appointment can become an entire day away from work. Transportation becomes part of the treatment plan. A missed appointment can become delayed care. And delayed specialty care can eventually become emergency care.

We can do better. Georgia does not have to start from scratch. We already know technology can help close this distance.

The Georgia Council on Lupus Education and Awareness previously worked with stakeholders on a telemedicine pilot in southwest Georgia, including the Dougherty County Health Department and rheumatologists from Emory University School of Medicine.

Georgia's Department of Public Health also operates Lupus ECHO, a virtual initiative designed to strengthen the ability of frontline providers-including primary care, emergency, urgent care, OB/GYN and dermatology providers-to recognize and manage lupus.

We have pieces of infrastructure. We have expertise. We have patients who need access. And now we have an unprecedented rural healthcare investment. What we need is the commitment to connect them.

I am calling for Georgia to establish a Rural Lupus Telehealth Demonstration as part of our broader rural health transformation strategy.

The model should connect rural hospitals, federally qualified health centers and community providers with rheumatologists and multidisciplinary specialists through a coordinated hub-and-spoken network.

Patients could receive appropriate follow-up care virtually while obtaining laboratory testing and other hands-on services locally. Rural physicians could consult specialists. Patient navigators could help families coordinate appointments, medications, testing and necessary in-person care.

Importantly, CMS has made clear that Rural Health Transformation funding may support collaboration in which specialists located outside rural communities provide telehealth support to rural residents.

The pathway exists. Now Georgia should use it. Build It. Measure It. Sustain It.

I am not calling for another short-term pilot that disappears when the grant ends. If Georgia wants to lead, we must build sustainability and accountability into the model from day one.

We should select rural communities across different regions of Georgia, establish baseline data and measure what matters: specialty-care wait times, miles of patient travel avoided, continuity of care, appropriate laboratory monitoring, emergency department utilization, hospitalizations and patient outcomes.

And we should ask another important question: Can telehealth extend Georgia's healthcare workforce?

We cannot place a rheumatologist in every rural Georgia community tomorrow. But we can bring rheumatology expertise into those communities today. That is what makes this proposal bigger than lupus.

If Georgia demonstrates that coordinated telehealth can improve access and outcomes for patients managing a complicated, multisystem chronic disease like lupus, we can create a blueprint for expanding specialty care for other chronic conditions.

Georgia should lead. This will require partnership among CMS, Georgia's congressional delegation, the Governor's Office, the Georgia Department of Community Health, the Department of Public Health, rural healthcare providers, academic medical institutions, health systems, rheumatologists, the Georgia Council on Lupus Education and Awareness, community organizations, patients and caregivers.

But most of all, it requires a decision. Are we simply going to spend rural health transformation dollars, or are we going to use this moment to transform rural healthcare? I am asking Georgia's federal and state leaders to make that commitment.

Establish the Georgia Rural Lupus Telehealth Demonstration. Fund it. Measure it. Create a sustainable reimbursement pathway. Scale what works. And position Georgia to become the national demonstration model for technology-enabled specialty care in rural America.

A Georgian living with lupus should not have to measure access to healthcare in miles. A rural zip code should not determine how quickly someone reaches a specialist. And a patient should not have to become sicker before specialized care becomes accessible.

We have technology. We have medical expertise. We have an existing foundation. And now we have significant federal investment. This is Georgia's moment to connect them.

Let us build a rural lupus care model strong enough to improve lives, measurable enough to prove that it works and sustainable enough for the rest of the nation to follow. Let Georgia lead.

Representative Kim Schofield represents the citizens of District 63, which includes a portion of Fulton County. She was first elected to the House of Representatives in 2017 and currently serves as Secretary of the Urban Affairs Committee. She also serves on the Creative Arts & Entertainment, Health, Industry and Labor and Small Business Development committees.

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The views expressed above and information shared are those of the author.