- A new bill on Capitol Hill seeks to help urban healthcare providers expand telemedicine programs to rural areas by giving them access to federal funds for broadband connectivity.
The bill is part of a full-court press by rural healthcare providers, state legislators, healthcare organizations and telemedicine experts to pressure the federal government to improve broadband connectivity to underserved parts of the country.
The “Reaching Underserved Rural Areas to Lead on Telehealth (RURAL) Act” was introduced this month by Sens. Brian Schatz, D-Hawaii, and Roger Wicker, R-Miss., two well-known supporters of telemedicine initiatives.
S.1377 seeks to allow non-rurally classified health systems to qualify for discounts in the Federal Communications Commission’s Healthcare Connect Fund as long as the money goes toward broadband services that would help people in rural areas.
“Our bill will give telehealth service providers better incentives to serve more rural areas,” said Schatz, a key sponsor of the Expanding Capacity for Health Outcomes (ECHO) Act, which became law earlier this year, and the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, now under consideration, in a prepared statement. “Ultimately, that is good news for anyone who cares about expanding access to health care in Hawai‘i and other rural areas across the country.”
“Telehealth services are critical to increasing rural Americans’ access to quality care,” added Wicker, also a sponsor of the CONNECT Act. “Mississippi is leading the nation in developing telehealth technology. Our health-care providers have demonstrated that targeted investments in telehealth can increase access to life-saving services and drive down costs.”
The bill, originally introduced in 2016, would update existing law to allow non-rural members of telehealth consortia to qualify for the HCF’s 65 percent healthcare provider broadband connectivity discount. The HCF was established by Congress in 2013 as part of the Universal Service Fund (USF) to support advanced telecommunication and information services for eligible healthcare providers.
Broadband connectivity is one of the chief impediments to the expansion of telemedicine services to rural areas. And it’s a popular topic these days in Washington.
Schatz and Wicker re-introduced their bill during a hearing this month on rural broadband support before the Senate Committee on Commerce Science and Transportation’s Subcommittee on Communications, Technology, Innovation and the Internet, one of at least three hearings that week that touched on better connectivity for rural regions of the country.
That hearing also heard testimony from one of the nation’s leading telehealth experts.
Karen S. Rheuban, MD, director of the University of Virginia Center for Telehealth, lobbied for increased funding to expand broadband services into rural areas.
“Affordable broadband connectivity is without question, the requisite underpinning of our telemedicine program, and as such, these efforts have changed the standard of care in rural Virginia,” Rheuban, a former president of the American Telemedicine Association, told the subcommittee.
Rheuban argued that rural areas need access to telemedicine – and, therefore, better broadband connectivity – because rural residents lack access to healthcare services and have a higher percentage of unhealthy habits and chronic diseases.
She noted a database created by the FCC’s Connect2Health Taskforce in which roughly half of the nation’s counties were identified as “double burden” counties, with high levels of chronic disease and a need for better broadband.
“More than 36 million Americans live in these double burden counties, according to the FCC report, where the fixed broadband access rate is 55 percent,” she said. “The FCC also found that in these counties, as an example, the prevalence of obesity is 19 percent above the national average, while the prevalence of diabetes is 25 percent above the national average. A lack of Internet access is also connected with challenges in seeing health professional. ‘Most of the counties with the worst access to primary care physicians are also the least connected,’ according to the FCC report.”
READ MORE: Taking Telehealth to Rural America
In 2015, a coalition of telehealth and health IT organizations, including the Healthcare Information and Management Systems Society (HIMSS) and the Personal Connected Health Alliance (PCHA), petitioned the FCC to improve wireless and broadband access to rural healthcare providers through resources like the HCF.
“The need amongst many rural healthcare providers for access to high quality broadband access is profound,” Thomas Leary, HIMSS’ vice president of government relations, and PCHA Vice President Robert Havasy wrote in a two-page letter of support. “This need for wireless and wireline broadband access represents a critical component to furthering a nationwide network optimized for tomorrow’s high-quality healthcare delivery systems. Benefits of expanded broadband access include the ability to conduct secure high quality eVisits such as telemedicine and expanded remote patient monitoring within the home.”
Issues with broadband access have also prompted state legislatures to speak out.
This past April, Alaska legislators issued a joint resolution urging the FCC to increase the budget for the Rural Health Care Universal Support Fund, which hasn’t budged from its $400 million limit since the fund was launched in 1997. That fund exceeded its limit this year for the first time.
In making their pitch for federal support for broadband, Alaska’s legislators pointed out that the Rural Health Care Universal Service Support Fund budget has never been adjusted for inflation, advances in technology or increases in demand; if it were adjusted for inflation alone, they said, the fund would total $600 million.
“The long-distance delivery of quality healthcare via telemedicine has made great strides in rural Alaska in recent years,” Rep. Bryce Edgmon (D-Dillingham), the resolution’s sponsor, said in a news release. “However, we’re about to hit a roadblock. Increasing the FCC support budget will allow healthcare providers in isolated communities to continue expanding local treatment options in ways we never could have dreamed of just a few years ago.”
“Telehealth allows patients in rural parts of Alaska access to state-of-the-art diagnostic tools and treatments that can help the sick and afflicted,” added Rep. Zach Fansler (D-Bethel). “This resolution puts the House on record supporting a proactive solution to a looming problem potentially jeopardizing healthcare for hundreds of thousands.”
Also this year, Montana legislators rejected a bill to set telemedicine practice standards because they worried residents in one of the nation’s most rural states wouldn’t have access to the technology.
State senators reportedly soured on the bill because it focuses on audio-visual telemedicine and bans phone-based consults as a means of establishing a doctor-patient relationship. More than half of the state’s residents reportedly don’t have access to sufficient broadband to support video consults, so a telephone might be their best link to telehealth.
Earlier this year, Wicker joined 40 other senators in a letter to newly appointed Health and Human Services Secretary Tom Price asking him to advocate for better patient care access in rural areas.
“We recognize that providers need to adapt to changes in the delivery of healthcare,” the letter stated. “We are encouraged by innovations we have seen in our states as providers test new care models and technologies like telehealth and remote patient monitoring.”
“We know you will find bipartisan interest in supporting these types of innovations, and we look forward to working with you to improve our healthcare system,” the senators added. “We recognize the importance of tackling this issue in a fiscally responsible way but believe investments in rural America yield substantial returns on investment.”