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
Expanding FCC connected health programs. FCC Chairman Ajit Pai in his keynote reinforced the agency’s interest and support of connected health initiatives, from rural to opioids. Most of the programs have a rural focus to bring broadband and telehealth/RPM to the ‘end of the line’ in underserved communities, something close to Mr. Pai’s heart as his parents were both rural physicians in Kansas..
- This summer, the Connected Care Pilot Program was proposed and approved unanimously in August [TTA 9 Aug]. Funding for this is proposed at $100 million.
- The spending cap for the rural healthcare program, which has been around since 1997’s dial-up days and now includes telemedicine and remote monitoring, was increased for 2017-2018 from $400 million to $571 million, a 43 percent increase. The FCC has pledged to fully fund 2018 programs.
- New initiatives were announced covering new uses for telehealth and remote patient monitoring:
- Connected care at home via RPM as part of the Connected Care Pilot Program
- Cancer care in partnership with the National Cancer Institute. The Launch program for rural and underserved communities aims to bring high-quality cancer care to where patients work and live through bringing together government, academia and community health providers.
- For opioids, there are two programs. One is expanding the mapping broadband health platform to include critical drug use data. This will allow users to rapidly visualize, overlay, and analyze broadband and opioid data together at the national, state, and county level. The second is to launch a chronic pain management and opioid use challenge as part of the pilot program. Mobihealthnews
A status report on NIH’s All of Us. Back in January as part of setting the stage for 2018, this Editor briefly mentioned the National Institute of Health’s massive All of Us program, part of the Federal Precision Medicine Initiative (PMI). All of Us needs almost all of us–their goal is to collect data on at least one million Americans for a major leap forward on data supporting population health. Dr. Dara Richardson-Heron, All of Us’ chief engagement officer, confirmed that over 100,000 participants have registered since the launch in May, with over 65,000 completing the full protocol. She mentioned that 75 percent of signups are from groups often underrepresented in modern medical research, with 50 percent from racial and ethnic minorities. The Mobihealthnews article ends on a ‘Debbie Downer’ note of doubting whether the program will reach enrollment goals, the cost will be justified, and whether the data will be kept private as promised.
MIT’s social robots may be the future of emotional support for wellbeing. MIT associate professor Cynthia Breazeal heads up the Personal Robots Group and is working on how to integrate AI into emotional robots for pediatric patients at Boston Children’s Hospital. The robots serve as a go-between child life specialists and the patient. The initial results were positive, with higher verbal scores (as a measure of engagement) than with stuffed bears or digital avatars. Professor Breazeal wants to extend the technology to older adults for wellbeing and engagement. Running against the conventional wisdom, their research found that older adults were more open to technology than the children. Following MIT’s work are companies like Hasbro and Embodied. Mobihealthnews.
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/08/Radio-tower.jpg” thumb_width=”100″ /]The digital divide comes one step closer to closing. Microsoft’s release of its white paper proposing an alternative to the expensive build-out of the US broadband network deserved more attention than it received in July. The Rural Broadband Strategy combines TV white spaces spectrum (the unused UHV television band spectrum in the 600 MHz frequency range which can penetrate through walls, hilly topography, and other obstacles) with fixed wireless and satellite coverage to economically deliver coverage to un/under-served areas versus fiber cable (80 percent savings) and LTE fixed wireless (50 percent).
34 million Americans lack broadband connection to the internet. Some of these are voluntary opt-outs, but 23.4 million live in rural areas without access, with huge economic consequences estimated in the hundreds of billions. TV white spaces can also expand coverage in small cities and more densely populated areas, including usages such as within buildings. This effort also presses the FCC, which in turn has pressed for broadband for two decades, to ensure that at least three channels below 700 MHz are kept unlicensed in all markets in the US, with more TV white spaces for rural areas.
The first part, the Rural Airband Initiative, builds on Microsoft’s present 20 programs worldwide, and is planned to connect 2 million people in by July 4, 2022, with 12 projects across the US running in the next 12 months. Much of the connectivity is dedicated to nonprofit efforts like 4-H’s digital literacy program and ‘precision agriculture’ in New York State and Washington. Microsoft is also granting royalty-free access to 39 patents and sample source code related to white spaces spectrum use in rural areas.
A positive move for telehealth’s spread. Rural healthcare providers pay up to three times as much for broadband as their urban counterparts. Telemedicine increasingly connects for consults between hospitals in rural areas and city-based health systems for specialty coverage and to provide assistance in specialized medical procedures. Telemedicine and telehealth remote monitoring has difficulty spreading with poor internet coverage; this has already been a barrier to patients in rural ACOs who can be 1-2 hours from the doctor’s office and notably for the VA in providing rural veterans with home telehealth support. Paramedics increasingly rely on internet connections and dropped connections lead ambulances to go to hospitals at a greater distance. If the FCC cooperates and Microsoft’s partners can find a way to profitably execute, broadband can finally achieve that promise about closing the ‘digital divide’ made back in the Clinton Administration. A Rural Broadband Strategy: Connecting Rural America to New Opportunities The Verge, mHealth Intelligence, Becker’s Hospital Review