- One of healthcare’s heavy hitters is lobbying the Federal Communications Commission to support primary care telemedicine in rural America by boosting resources for broadband expansion.
Arguing that improved broadband access will boost telehealth programs in remote communities and for underserved populations, the American Association of Family Physicians (AAFP) is urging the FCC to make several changes to the Rural Health Care (RHC) program, including increasing the budget from its capped $400 million limit and allocating future funding based on the economic needs of the rural population served by a particular practice.
“Telehealth technologies can enhance patient-physician collaborations, increase access to care, improve health outcomes by enabling timely care interventions, and decrease costs when utilized as a component of, and coordinated with, longitudinal care,” AAFB Board Chairman John Meigs, Jr., MD, wrote in a letter to FCC Secretary Marlene H. Dortch. “Responsible care coordination is necessary to ensure patient safety and continuity of care for the immediate condition being treated, and it is necessary for effective longitudinal care.”
The letter comes in response to a proposed rule published on January 3 in the Federal Register that lays out a wide range of changes planned by the FCC, including raising the RHC budget cap, which has remained at $400 million since the program was launched in 1997.
Congress established the RHC Program in the Telecommunications Act of 1996, and set a $400 million cap on RHC’s Telecom Program “to subsidize the difference between urban and rural rates for telecommunications services.” A second part of RHC, the HCF Program, was established in 2012 to allow telecoms to provide a flat 65 percent discount on a variety of communications services “to promote the use of broadband services and facilitate the formation of healthcare provider consortia.”
But driven by a strong interest in telemedicine and telehealth services, as well as educational outreach programs, the RHC Program exceeded the cap by $20 million in FY 2017; the agency expects the cap will be surpassed by increases in both funding requests and the number of projects in FY 2017, which runs through June 20, 2018.
In December, the FCC voted to carry forward unused funds from past years to cover additional FY 2017 expenditures on a one-time-only basis. The agency is now looking for a formula to adjust the cap each year. One suggestion is to adjust the cap annually for inflation.
“In this proposed rule, the FCC asks for comments regarding whether the Commission should adjust the $400 million cap annually,” the AAFP letter states. “The FCC provides an example, noting if indeed the Commission had adjusted the $400 million cap annually for inflation each year from 1997 forward, and had based adjustment for inflation ‘on the GDP–CPI (which the E-rate Program uses to adjust its cap),’ then the Rural Health Care (RHC) program cap would have been approximately $571 million for FY 2017. The AAFP urges the FCC to adjust for inflation and to also consider the price fluctuation in technology.”
The organization also recommends that unused funding from one year be automatically rolled over to the next, as some telemedicine and telehealth programs encounter delays, but that a second year roll-over be granted only through a special approval process by the FCC.
In making these and other comments on the RHC program, AAFP officials said they’re looking to level the playing field for rural providers. Too many funding decisions, they said, are based on financial goals rather than clinical outcomes or care coordination.
“We believe the FCC’s RHC program has an important role to play to ensure disparities are not widened for those in rural areas, including disparities tied to lack of timely access to quality health care which telemedicine and telehealth may help alleviate if conducted in a manner supportive of longitudinal care,” the letter states. “For example, policy which supports incorporating telemedicine and telehealth capabilities within rural physician/providers’ practices and enables the primary care physician providing longitudinal care to reach out via technology to secure an e-consult with a specialist in a timely manner, which could otherwise take weeks or months for the patient to access, would support provision of cost-effective, responsible longitudinal care. On the contrary, policy which only supports the continuance or expansion of direct-to-consumer telehealth services would lead to care provided in silos, which can fracture care and increase total cost of care.”
The AAFP concluded its three-page letter with a plea to address the inadequate supply of rural physicians.
“A balanced and cooperative effort among those involved in medical education is needed to promote rural practice,” the organizations said. “This includes increased recruitment of medical students from rural backgrounds; active teaching, both at the academic medical center and the community level, of skills needed in rural settings; as well as providing necessary funding for rural medical education on the federal, state and private level. All need to work together to provide support for the training of future rural physicians.”
Several healthcare organizations, consortia and providers have lobbied the FCC and Congress to increase federal support of broadband expansion, including the American Hospital Association, American Medical Informatics Association, American Telemedicine Association, Healthcare Information and Management Systems Society (HIMSS), Personal Connected Health Alliance (PCHA), the Alaska Collaborative for Telemedicine and Telehealth, Alaska Native Health Board, Arizona Hospital and Healthcare Association, California Telehealth Network, CHRISTUS Health, the Indiana Rural Health Association, the New England Telehealth Consortium, the North Carolina Telehealth Network, the Southern Ohio Health Care Network and the University of New Mexico Center for Telehealth.
Most of those groups signed a letter last November to U.S. Reps. Greg Walden and Frank Pallone, the chairman and ranking member of the House Energy and Commerce Committee, asking that the RHC Program’s cap be doubled to $800 million.
The College of Health Information Management Executives (CHIME) added its support this month, calling on the FCC to raise the cap to $800 million. CHIME CEO Russell Branzell and Board Chairman Cletis Earle also urged the FCC to work with other groups to support telemedicine uses to combat the nation’s opioid abuse epidemic.