Telecare – time to sweat the analogue assets, not dump them

Veteran Editor Charles climbs on his soapbox, one more time.

There must have been a moment, somewhere, when a bronze age warrior realised that iron really cut the mustard (and other things) better. Unfortunately, that resulting genetic preference for new over old has left us open to the blandishments of salespeople through the ages, encouraging us to take every opportunity to buy new and cast out old.

And it costs! A current example is the drive by many telecare companies to use the digitalisation of the telecoms network in the UK to encourage users to ditch their analogue equipment in favour of their new shiny digital kit…when there’s no need. The telecare world has of course an honourable tradition of encouraging box shifting – back when I ran a telecare programme at LB Newham, in 2007 the government was encouraged to offer a Preventive Technology Grant to all local authorities. Perhaps the most memorable campaign though was Three Million Lives which, from the outside, appeared to have that one aim. Indeed there must be few telecare consultants who have not at some point in their career opened a cupboard to find the shelves heaving with unused – and sadly in a few cases unusable – kit.

Wise telecare providers will resist the current pressures though – both BT and Virgin have been provided with a wide range of old analogue telecare kit to test in their digital simulators alongside the appropriate digital/analogue converters and, I am reliably informed, it has worked well every time. Some companies, I am told, may not have taken full advantage of these facilities and only tested their new digital offerings, whilst ignoring analogue; I’ll leave the reader to work out why they might have done that. This is important because telecare kit is built to last and whilst some service users will benefit from the latest tech wizardry, most will be completely happy with the older kit – indeed those with dementia may find it impossible to get used to any new kit, providing one more incentive not to change. The original cost of that analogue kit must conservatively be well over £500 million, so it would seem to be a crying shame just to dump it whilst it still works well – indeed with local authority budgets as they are, it effectively would hugely reduce their ability to provide a service for all who want it.

There is of course one potential issue, as no power comes down the fibre telecoms lines, unlike with copper, so the service could fail in a blackout. However I understand that both BT and Virgin are working on solutions to this. GSM alarms, supposedly the future, are also vulnerable; indeed apparently this already happened a a few weeks back when the country suffered widespread power outages, when mobile networks failed in some areas. I understand that many masts don’t currently have a power back-up for such occasions and those that do only last 30 minutes.

So, if you are responsible for a telecare provision budget and a nice salesperson pops by to encourage you to switch out your old, ask them how their old kit behaved in the network simulations when paired with an appropriate converter.

If they tell you anything other than that it went really well, look askance. If they say they haven’t tested their old kit, ask them why not.

News and event roundup: Amazon PillPack, Humana joins CTA, NH’s telemedicine go, Fitbit Lives Healthy in Singapore, supporting Helsinki’s older adults, events

Now that we are past the unofficial end of summer, it’s time to spin that lasso and rope us some news.

Amazon’s PillPack loses a critical data partner. Electronic prescriptions clearinghouse Surescripts terminated their data contract with ReMy Health, which supplied PillPack with information on patients’ prescriptions. Surescripts found fraud in several areas of their relationship with ReMy Health including medication history, drug pricing, and insurance billing. Now PillPack has to obtain it the old-fashioned way–by asking the patient. This can lead to errors and inaccuracies in things like dosages and whether a drug is brand-name or generic. Now PillPack, in the lurch, is seeking a direct relationship with Surescripts. Seeking Alpha, CNBC

Health plan Humana is the first payer to join the Consumer Technology Association (CTA). Humana has been building up his data analytics and digital health capabilities with new ‘studios’ in Boston and hiring USAA’s CTO.  It’s piloting an app for Medicare Advantage patients to connect them with pharmacists and medication management via Aspen RxHealth plus working on a virtual digital primary model with telemedicine provider Doctor on Demand. Fierce Healthcare

New Hampshire is joining the telemedicine reimbursement bandwagon, with its legislature and Gov. Sununu approving primary care providers and pediatricians to bill Medicaid and private insurance for telemedicine visits starting in January 2020. This also ties into rural telehealth. AP, Mobihealthnews

Internationally….Fitbit is partnering with Singapore’s Health Promotion Board (HPB) for the Live Healthy SG behavioral change program, based on the Fitbit Premium program, starting in late October. Mobihealthnews A-P   In Finland, Digital Service Center Helsinki is creating digital tools and virtual care systems to enable older adults to safely and independently live at home, including socialization to prevent loneliness. It’s a significant challenge as over 22 percent of Finland’s population is over 65. Mobihealthnews Europe-UK

Events:

The 9th International Digital Public Health Conference series (#DPH2019), 20-23 November, Marseille, France. This conference is billed as the digital health partner of the 12th European Public Health Conference and brings together the areas of public health, computer and data science, medtech, and NGOs. Conference information here.

Aging 2.0 New York Global Innovation Showcase 4 December, NYC. One of a series of global Aging 2.o events, startups will present aging-focused innovations. Want to pitch? It’s still open–apply here. Register to attend here. Additional information on this and on CREATE’s Design for Older Adults Workshop on 21-22 October at Weill Cornell is here.

 

Shock news: the CVS-Aetna merger officially approved after 9 months

Go away on holiday, Judge Leon finally jumps into the hole. It took two months from the last hearings in mid-July, and nine months in total (delivered after last year’s Thanksgiving turkey) but Judge Richard Leon of the Federal District Court finally–and somewhat unexpectedly–ruled that the CVS-Aetna merger could be at last a Done Deal.

The Final Judgment goes into extensive detail about the Medicare Part D divestiture by Aetna to WellCare, complete with a Monitoring Trustee. On the very last page, Judge Leon admits that the merger is in the Public Interest.

The entire process, which is chronicled here, was unprecedented in the annals of Federally approved mergers. Usually a District Court Tunney Act review of a merger already through the wringer of the DOJ and the states is brief. Judges don’t make headlines, save when their rulings are the coup de grace (see: Aetna-Humana, Anthem-Cigna). Instead, Judge Leon called hearing after hearing, witness after witness from the AMA to PIRG, opining all the way, even turning away five supporting states petitioning (in vain) to be heard.

This high-profile precedent doesn’t bode well for future mergers, especially for healthcare. Fierce Healthcare, Columbus Dispatch

Doro AB acquires Invicta Telecare from Clarion Housing, increasing to nearly 200,000 users (UK)

While this Editor was on holiday, Sweden’s Doro AB increased its presence in the UK with the acquisition of Invicta Telecare, parent of Centra Pulse and Connect. Invicta’s products will join the Welbeing PERS service. which at the time of their acquisition last June had about 75-80,000 users [TTA 7 June 18].

Invicta was sold by Clarion Housing Group, the UK’s largest social housing association, which includes a property development company and a charitable foundation. Invicta’s 2018 revenue was £6.3 million. Like Welbeing, Centra Pulse offers basic and mobile PERS, but also has multi-sensor in-home connected home capability. It is also one of the top three UK monitoring services and is a major provider of after-hours contact services for telecare providers, such as housing associations and local authorities. The sale was effective on 1 September.

The UK remains the largest telecare market in the European region with an estimated 1.8 million telecare connections. It faces a transition to digital from analog systems which affects social care spending and residential service capabilities. Doro operates in the UK and about 40 countries, with a core business in mobile phones specially designed for older adults. Doro announcement, press release

Digital Mental Health for Adults – a one day conference at the RSM on 23 September 2019 in London

The next event run by the Royal Society of Medicine’s Digital Health Council, on 23rd September, focuses on digital mental health for people over 18. There are two main sides in the high level discussion around this topic. There is an increasingly active (and commercially burgeoning) group of companies and individuals who believe that there are a digital tools that can help to screen, manage and in some cases treat people with mental health issues (or who suspect they may have one). Some of these are simply ways of digitally enabling remote conversations between mental health care providers and those that require advice or care. Some are AI driven tools that to some degree replace the human element of care and support. The event will discuss whether this not only addresses workforce issues but also delivers clinical efficacy.

On the other hand, many believe that the use of digital technologies can adversely affect the mental health of people who use them, often to excess. Do the potential benefits outweigh these negative factors, or is a digital detox something that your GP may soon be prescribing?

Come along and get involved! Booking is here – tickets start at £20 (RSM student rate) for the day including a delightful lunch.

A realistic look at why telemedicine isn’t succeeding in nursing homes

It’s the reimbursement. Telemedicine in nursing homes by specialists on call seems like a natural. A nursing home resident is usually older and frail. Nursing homes don’t generally have doctors in the facility; only 10 percent are estimated to have on-site doctors. A telemedicine consult administered by a nurse or even a trained assistant can provide proactive, just-in-time care, and possibly prevent an expensive hospital/ER visit–two-thirds of which may be potentially avoidable. That ER visit also can start a disastrous and expensive decline in the resident. 

So the problem in the stars is…economics.What insurance companies pay for telehealth/telemedicine services. It varies if the patient is covered by Medicare, Medicaid, or dual-eligible–and also by private or LTC insurance. Some providers and payers are engaged with value-based care and payment models–others are not. CMS is concerned that telehealth drives up costs, not reduces them. Finally, administrators and nursing/clinical staff in the facility are not necessarily comfortable with technology in general. (Excel spreadsheets are, believe it or not, foreign to many.)

As Readers know, Call 9 couldn’t figure out the reimbursement problem nor how to keep up with payer demands–and ceased business [TTA 26 June]. Others like Curavi and Third Eye Health provide a video cart and provide on-demand consults. On the Federal level with Medicare, payments have been expanded for end-stage renal disease and stroke treatment, and Medicare Advantage plans can now offer telehealth. Still, there is no direct payment under Medicare for virtual emergency medicine. And telemedicine remains a rarity in SNFs, who prefer to send their residents to ERs ‘just to be sure’. POLITICO

Are AI’s unknown workings–fed by humans–creating intellectual debt we can’t pay off?

Financial debt shifts control—from borrower to lender, and from future to past. Mounting intellectual debt may shift control, too. A world of knowledge without understanding becomes a world without discernible cause and effect, in which we grow dependent on our digital concierges to tell us what to do and when.

Debt theory and AI. This Editor never thought of learning exactly how something works as a kind of intellectual paydown of debt on what Donald Rumsfeld called ‘known unknowns’–we know it works, but not exactly how. It’s true of many drugs (aspirin), some medical treatments (deep brain stimulation for Parkinson’s–and the much-older electroconvulsive therapy for some psychiatric conditions), but rarely with engineering or the fuel pump on your car. 

Artificial intelligence (AI) and machine learning aren’t supposed to be that way. We’re supposed to be able to control the algorithms, make the rules, and understand how it works. Or so we’ve been told. Except, of course, that is not how machine learning and AI work. The crunching of massive data blocks brings about statistical correlation, which is of course a valid method of analysis. But as I learned in political science, statistics, sports, and high school physics, correlation is not causality, nor necessarily correct or predictive. What is missing are reasons why for the answers they provide–and both can be corrupted simply by feeding in bad data without judgment–or intent to defraud.

Bad or flawed data tend to accumulate and feed on itself, to the point where someone checking cannot distinguish where the logic fell off the rails, or to actually validate it. We also ascribe to AI–and to machine learning in its very name–actual learning and self-validation, which is not real. 

There are other dangers, as in image recognition (and this Editor would add, in LIDAR used in self-driving vehicles):

Intellectual debt accrued through machine learning features risks beyond the ones created through old-style trial and error. Because most machine-learning models cannot offer reasons for their ongoing judgments, there is no way to tell when they’ve misfired if one doesn’t already have an independent judgment about the answers they provide.

and

As machines make discovery faster, people may come to see theoreticians as extraneous, superfluous, and hopelessly behind the times. Knowledge about a particular area will be less treasured than expertise in the creation of machine-learning models that produce answers on that subject.

How we fix the balance sheet is not answered here, but certainly outlined well. The Hidden Costs of Automated Thinking (New Yorker)

And how that AI system actually gets those answers might give you pause. Yes, there are thousands of humans, with no special expertise or medical knowledge, being trained to feed the AI Beast all over the world. Data labeling, data annotation, or ‘Ghost Work’ from the book of the same name, is the parlance, includes medical, pornographic, commercial, and grisly crime images. Besides the mind-numbing repetitiveness, there are instances of PTSD related to the images and real concerns about the personal data being shared, stored, and used for medical diagnosis. A.I. Is Learning from Humans. Many Humans. (NY Times)

CMS’ three new proposed telehealth codes, changes on inclusions, in 2020 Medicare Physician Fee Schedule (US)

A little-noticed part of the Center for Medicare & Medicaid Services’ (CMS) annual proposed Physician Fee Schedule rule (Federal Register) for Medicare payments is that CMS on its own, without any provider requests (surprisingly), has proffered three new reimbursement codes, all centered on opioid use treatment:

HCPCS code GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month.

HCPCS code GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month.

HCPCS code GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).

These are classified as Category 1 as they are similar to services already offered under telehealth, so are likely to go into effect on 1 January.

This adds to telehealth services under the SUPPORT Act that removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD). effective 1 July.

Most telehealth services to beneficiaries (Medicare-speak for patients) eligible for reimbursement are limited to qualifying rural areas or one of eight types of qualifying sites and the practitioners are included in one of ten categories of distant site practitioners eligible to furnish and receive Medicare payment for telehealth services. Services also have to be through real-time audio/video and the code (Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCs) are included under Medicare.

Comments on the Rule are accepted through 5pm on 27 September. National Law Review has the details for filing comments here.

The Breach Barometer hits a new high for healthcare–and the year isn’t over

31.6 million healthcare breached records can’t be right? But it is, and it’s double all of 2018. Protenus’ Breach Barometer for the first six months of the year tallied over double the number of patient records breached calculated for 2018 (15.1 million). The number of breach incidents reported was smaller–285 breach incidents disclosed to the US Department of Health and Human Services or the media–compared to 503 breaches in 2018, which means that individual data breaches affected far more records.

Hackermania is running wilder than ever. Nearly half the breaches were due to hacking. The big kahuna of breaches this year was reported in May at American Medical Collection Agency, a third-party billing collections firm. This eight-month breach affected 20 to 22 million records at Quest Diagnostics, LabCorp, Opko Health, under one of its subsidiaries, BioReference Laboratories, Inc., and Clinical Pathology Laboratories [TTA 5 June] This hack also involved Optum360, a Quest contractor and part of healthcare giant Optum. In terms of PII, the records breached included SSI, DOB, and physical addresses.

 Yet insider breaches are still a significant threat at 21 percent, whether from errors without malicious intent or deliberate wrongdoing. In the report, Protenus (with DataBreaches.net) calculated that 60 of the 285 breaches were insider-related affecting 3.5 million records. 35 were insider-error incidents, with 22 additional due to wrongdoing.

When it comes to breaches, the trend is easily not healthcare organizations’ friend, as 2018 tripled 2017’s total breached records. This is despite the new emphasis on healthcare IT security and insider training. Protenus release, FierceHealthcare, Protenus first half report (PDF)

LIVI telemedicine app expands availability to 1.85 million patients with GPs in Birmingham, Shropshire, Northamptonshire, Southeast

The LIVI telemedicine app, which made news last year with UK partnerships in Surrey and Northwest England last year, has expanded to GP practices in Birmingham, Shropshire, Northamptonshire, and locations in the Southeast, as well as additional practices in Surrey. The Northampton General Practice Alliance and the Alliance for Better Care are among the federations partnering with LIVI.

LIVI offers NHS and private services for video consults with a GP. Patients can also access medical advice, referrals, and prescriptions. Unlike Babylon Health, the patient can use LIVI without having to register with a new, Babylon Health-linked practice and deregistering from the former GP practice. It is now available to 1.85 million UK patients. Known as Kry in the Nordic countries, LIVI also has a presence in France. 

In January, LIVI also acquired some notoriety when their current VP of product, Juliet Bauer, departed her chief digital officer spot with NHS England after an all-too-glowing article about LIVI’s Surrey pilot in The Times–without disclosing that she was joining the company in April [TTA 24 Jan] leading to charges of the ‘brazenly revolving door’ et al.

Allscripts reaches deal with DOJ on Practice Fusion in compliance settlement for $145 million

EHR giant Allscripts settled with the US Department of Justice on compliance charges made against Practice Fusion. Allscripts acquired Practice Fusion, a free/low-cost EHR targeted to primary care practices, in January 2018. A year earlier, Practice Fusion had received an inquiry from the US Attorney’s Office for the District of Vermont examining the company’s compliance with the EHR certification program. According to Fierce Healthcare, after Allscripts acquired Practice Fusion, the inquiry expanded…and expanded…to include additional certification and Anti-Kickback statute charges. Since then, Allscripts has rebranded the EHR as Veradigm.

The announcement was made during their 2019 Q2 results investor call. Their president claimed the $145 million settlement, at this point an agreement in principle with DOJ, is in line with other EHR-DOJ settlements. 

Consider it a final payment on the knockdown price ($100 million) Allscripts paid for Practice Fusion.

Their Q2 bookings were $276 million, up 31% from the prior-year period, but revenue at $445 million was lower than expectations. 

2020 GSK IMPACT/The King’s Fund Awards now open for applications (UK)

The King’s Fund has announced that the GSK IMPACT Awards, which provide funding, training, and development to charitable organizations in health and wellbeing, are now open for 2020 applications. Applicants should be registered charities that are at least three years old, working in a health-related field in the UK, with a total annual income of between £80,000 and £2.5 million. It’s open only to 23 September so you may want to read The King’s Fund page on their work with charitable organizations, their learnings about the challenges they face–and how to apply. Interested in 2019? Read our article on the winners here.

Comings and goings, short takes, and in other news…: Vivify’s new SVP Sales, Parks’ Connected Health Summit, $35M for 3D portable ultrasound, Oxford Medical Sim new pilot

In comings and goings….remote patient monitoring company Vivify Health announced that Chris Fickle has joined them as Senior Vice President, Sales. Mr. Fickle was previously with Qualcomm as senior director, business development including international and in the home health market as general manager of Healthfield and American HomePatient. Vivify currently has customers such as UPMC, Trinity Health, and the Ontario (Canada) Telemedicine Network and provides remote care management through personalized care plans, biometric data monitoring, and multi-channel patient education. Certainly in the umpteenth iteration of their website and June’s MedTech Breakthrough Award, they have apparently bounced back from their bounce-out from their VA award in early 2018 [TTA 14 June 18 and 16 Jan 18].

A reminder that Parks Associates’ Connected Health Summit in San Diego is now open for registration. TTA has been in the past a formal media supporter of the CHS and while not this year, it’s a great way to spend a few days in late August. The location, content around the demand for both clinical and consumer health and wellness solutions aimed at improving the quality of life for people living and seeking support at home, and the speaker list has always been outstanding. Follow their Twitter feed at @CONN_Health_Smt | Hashtag: #CONNHealth19. And register here.

This Editor has been following handheld ultrasound since GE Healthcare debuted the VScan in what seems an eternity ago (only 2010!) –and yes, it’s still around–Mobisante demonstrated at TED by no less than Eric Dishman in 2013–and last year the locally-based Butterfly IQ hit the market at about half the price and raised $250 million. Now Redwood City, California startup Exo Imaging has gained a $35 million Series B round to develop its portable ultrasound that through AI assistance generates a 3D image. Release. Mobihealthnews

The UK’s Oxford Medical Simulation has picked up another pilot of their Oculus Rift VR headsets to simulate in-practice interactive patient treatment at the OxSTaR (Oxford Simulation, Teaching and Research) center, part of  John Radcliffe Hospital, Oxfordshire. We covered OMS in April with their pilot with Health Education England Wessex at the Portsmouth and Southampton Hospitals. Mobihealthnews

 

Technology will help ease, but not replace, rising workforce demand in long-term care: UCSF study

A just-published research paper by researchers at the University of California, San Francisco Health Workforce Research Center on Long-Term Care, has come to the not entirely unsurprising conclusion that the current technology targeted to the LTC area is helpful but won’t displace any workers from their jobs in the immediate future. The qualitative study evaluated 13 current health tech technologies in 14 areas for their potential impact on the care of older persons as it affects LTC workforce recruitment, training, and retention. 

Some key findings were: 

  • Technology will not even come close to replacing the LTC workforce. At most it will aid LTC workers.
  • Tools such as data collection and remote patient monitoring systems that distribute data to the care team can improve staff’s understanding of client behavior and manage day-to-day tasks
  • Technology can also address workforce recruitment, retention, and staffing efficiency, such as predictive analytics used in identifying candidate suitability, improved staff management in shift scheduling, work location, and clientele, and real time location tracking, can improve the work environment
  • Technologies that monitor health and activity measurements, integrating with predictive modeling, can benefit clients, family caregivers, and care teams, but may suffer from complexity and duplication in their category. 
  • Educational tools also improve care delivery by instructing on proper caregiving techniques, increasing knowledge on medical or behavioral conditions, and by promoting sympathy/empathy

Some of the barriers included:

  • It comes at a cost which LTC is reluctant to pay
    • Initial and ongoing cost with lack of third-party Medicare/private reimbursement
    • Dependence on unattractive long term subscription-based models 
  • Threats to privacy and the security of health data
  • Potential differences in product specificity or acceptance among diverse racial and ethnic groups
  • Technology lacking user-centered design and not developed/tested in conjunction with real-world LTC 
  • Funding: only two US VCs fund LTC tech is a bit of an exaggeration, but the pool of interest is shallow nonetheless

The overall conclusion struck this Editor as less than enthusiastic, perhaps because We’re Not There Yet and it’s still so far away.

The appendix lists the 13 companies surveyed with summaries of each health tech company interviewed: Alma’s House (Sweden), Arena (staffing/recruitment), Canary Health (education/caregiver education), CarePredict (wearables/alert monitoring), Clear Care (management). Embodied Labs (education), Intuition Robotics (ElliQ), GrandCare (monitoring/client engagement), Honor (staffing), La
Valeriane (documentation), LifePod (voicetech/monitoring), UnaliWear (wearables/monitoring), VisibleHand (documentation/EHR).

The study was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS).com. UCSF summaryThe Impact of Emerging Technologies on Long-Term Care & the Health Workforce (full text)  Hat tip to Laura Mitchell of GrandCare via Twitter

Can a smartphone camera, app, and device detect viruses at low cost?

A team of researchers led by the University of Tokyo’s Yoshihiro Minagawa has developed a mobile-based portable viewing and diagnostic platform for viruses, which may be a breakthrough in diagnostics for rural and underserved global areas. The viewer is about the size of a standard brick and performs the digital enzyme assay using cavities lit with an LED to create light spots detectable by the camera.  The smartphone camera fits on top of a lens on the top of the box. Right now it detects only about 60 percent of what can be detected by a fluoroscopic microscope, but its speed and portability are major assets in these early tests, as well as versatility in possibly detecting other biomarkers. Mobile imaging platform for digital influenza virus counting (Lab On A Chip–Royal Society of Chemistry) Supported by the ImPACT Program of Council for Science, Technology, and Innovation (Cabinet Office, Government of Japan) Also Mobihealthnews APAC.

FCC reforming Rural Health Care Program to improve telehealth funding in addition to Connected Care Pilot (US)

The Federal Communications Commission (FCC) voted last week to adopt a 151 page “report and order” which will reform how the agency distributes money for rural telehealth support and broadband services through the Rural Health Care Program. Rural telehealth has been one of the FCC’s most popular programs with demand exceeding funding.

The new policy will, according to the order:

  • Reduce fraud, waste, and abuse (FWA)
  • Streamline and simplify the calculation behind the discounted communication rates that healthcare providers pay
  • Move to create a database of rates (transparency)
  • Simplify the application process
  • In the likely event that demand for the RHCP exceeds its funding cap (currently $571 million), the program will target funding to the most rural areas (based on rurality tiers) and those facing shortages of health care providers
  • Directs the Program Administrator to take additional actions to increase transparency in the program and applicants receiving timely, complete information

According to Modern Healthcare, subsidies on the telecom rates will be based on the median rates telecommunications providers charge for similar services in the state and the rurality tier (how rural the location is) for the healthcare provider. There is some bi-partisan debate on delaying the change due to local concerns, the level of funding (generally seen as too limited) and the relative experience of the Universal Service Administrative Company to determine those rates. Some urban areas do receive funding in the program, which is a puzzle to this Editor, but was probably baked in from its start in 1997 when certain neighborhoods had little connectivity. The FCC is also proposing a cap on Universal Service Fund programs, one of which is the RHCP. Sen. Marsha Blackburn also entered a bill which would direct the FCC to develop guidance on cross-state telehealth in the Telehealth Across State Lines Act of 2019. POLITICO 2 Aug.

The RHCP is separate from the Connected Care Pilot, which moved ahead in July and will bring telehealth services directly to rural low-income patients and veterans. The Notice of Proposed Rulemaking (NPRM) was issued on 10 July. One wishes that this bickering Congress would understand the importance of both programs. FCC release, TTA 20 June