A bill to establish Medicare coverage for audio-only telehealth services is now in the House, setting the stage for a debate on whether the telephone is a good healthcare tool.
The debate over whether to allow Medicare coverage for audio-only telehealth services is now before Congress.
US Reps. Jason Smith (R-MO) and Josh Gottheimer (D-NJ) this week introduced the Permanency for Audio-Only Telehealth Act (HR 3447), which would establish coverage for healthcare providers who connect via phone or non-video telehealth platforms with patients who don’t have the resources to use video-based telehealth.
The bill would also remove geographic and originating site restrictions on Medicare coverage, allowing providers to collaborate with patients in their homes.
“The COVID-19 pandemic required the U.S. healthcare system to innovate and embrace every viable method of healthcare delivery. For patients in rural areas back home in Missouri, none have been more beneficial than the expansion of audio-only telehealth,” Smith said in a press release. “This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight.”
Audio-only telehealth is a hot topic right now, with its supporters and opponents. The modality had been largely prohibited or strictly regulated prior to the pandemic, but has seen increased use thanks to emergency measures expanding access to and coverage of telehealth.
But those freedoms will end
Supporters not that many underserved and rural populations don’t have access to broadband resources needed to support audio-visual telemedicine technology, and they may not have the money to buy a smartphone, laptop or computer and Wi-Fi connectivity. In those cases a landline telephone may be the only good contact they have with care providers.
Organizations like the American Medical Association, Medical Group Management Association, Healthcare Leadership Council and Better Medicare Alliance have come out in favor of audio-only telehealth coverage, saying it improves access to care for a significant number of people who haven’t been able to access care.
“During the COVID-19 pandemic, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits,” Andres Gilberg, senior vice president of government affairs for the MGMA, said in the press release. “The need for these services will not disappear upon the conclusion of the COVID-19 public health emergency, but the ability to deliver them to Medicare beneficiaries will without congressional action. Patients should not be penalized for living far away from healthcare facilities or living in areas with inadequate internet access.”
Opponents argue the modality isn’t good enough to establish a doctor-patient relationship or to ensure privacy and security.
Most agree that if the modality is covered, the Centers for Medicare & Medicaid Services would need to develop guidelines as to how the platform can be used by providers, setting strict rules on what services can be provided.
If you’d talked to Brandon Welch in 2013, he probably wouldn’t have expected to be the CEO of a global leader in telemedicine.
Back then, Welch was a University of Utah doctoral student working on a hospital study to make prenatal checkups easier for pregnant women. Virtual visits made sense, but existing HIPAA-compliant platforms were complicated and expensive, so he built his own technology—just for the project.
That led to use in a few more telehealth studies and to the launch of Doxy.me, a startup that offered a basic, secure platform for telehealth visits and a paid version with more features. The business grew through word of mouth, but it wasn’t intended to be a huge moneymaker. At one point, Welch took another job as a professor at the Medical University of South Carolina, while his co-founder Dylan Turner couch-surfed and worked in Salt Lake City coffee shops until the business paid his salary.
The Doxy.me platform, courtesy of Doxy,me
The pandemic created a rush for telehealth services
As you might have guessed, COVID-19 changed everything. Virtually overnight, doctors across the globe scrambled to figure out how to see patients remotely. Today, Doxy.me owns 30 percent of telehealth market share and has revenues in excess of $50 million. But this kind of fast growth was like walking a tightrope. “It was controlled chaos there,” says Welch. “And there were some white-knuckled moments.”
That was the case for many of Utah’s healthcare providers, its small number of telehealth platforms, and the state’s desperate patients. The number of telehealth medical claims in the state jumped 9,614 percent between December 2019 and December 2020, according to the nonprofit FAIR Health. Utahns mostly flocked to the web to see doctors and therapists for mental health, physical therapy, and specialists for respiratory, heart, and soft-tissue diseases.
“We’ve gone from telehealth being a novelty to being an accepted manner of care,” says Kerry Palakanis, director for ConnectCare, the telehealth arm of Intermountain Healthcare. Intermountain pioneered this telehealth platform in 2015 and saw its telemedicine appointments double early in the pandemic. “We were ready,” she says.
Welch, however, was caught off-guard by the sudden demand. Doxy.me had grown to 89,000 users in its first seven years. So on March 1, 2020, Welch was surprised when 100 providers signed up for the service— five times more than normal. He figured it was a fluke, but a friend in the United Kingdom warned Welch that this COVID thing might be a big deal. “We said, no that’s not going to be anything,” Welch recalls.
By the week’s end, Welch realized it was indeed a huge deal. By that point, 600 to 700 providers were signing up per day. The Doxy.me team jumped into action adding three new servers and automated bots to answer customers’ questions. They paused live onboarding sessions and created a YouTube video explaining the platform for new signups. “We used hundreds of support requests to refine the support and answer questions on our website,” Welch says.
Two weeks in, 5,000 people signed up in one day. The next day, 10,000 people signed up. The next day, 20,000 people. Two months into nationwide lockdown, Doxy.me ballooned to 600,000 providers and nearly 1 million sessions a day—up from the pre-pandemic base of 80,000 users and 12,000 daily sessions.
The fast growth blew Welch’s mind, and though it was a blessing, he knew if not handled properly it could crush the company. Doxy.me aggressively recruited at its Salt Lake and Charleston, S.C. offices, ramping up to 120 people from 10 employees the past year.
In those first few months of the pandemic, new recruits—some of these hires had been previously laid off from the restaurant business—holed up in Welch’s living room, building software, fixing bugs and answering support questions, working 12-hour shifts, stopping for dinner, then returning to work from 9 pm to 1 am.
Soon, Welch’s original pursuit of simplicity and easy access to telehealth became a magnet to providers everywhere. Other telehealth platforms might require weeks or months of onboarding before doctors or clinics could start seeing patients online, and video platforms like Zoom weren’t encrypted end-to-end. Doxy.me uses no computer in the middle to transfer information. The site doesn’t collect data and users are anonymous.
About half of Doxy.me’s users subscribed to the free version, which provided a basic room for a doctor and patient. The paid plans offered more perks, such as analytics, branding, billing, multiple rooms, and more. Suddenly, massive hospital networks with thousands of doctors wanted Doxy.me, and the team quickly created a new plan and features that could accommodate them, and also added seven more servers and built a chatbot to more quickly move people through virtual waiting rooms and into doctors’ “examination rooms.”
Brandon Welch, CEO, Doxy,me, courtesy of Doxy.me
The pandemic created demand for (and destigmatized) virtual therapy
While Welch scrambled to deliver on the hospitals and clinic front, entrepreneur Dallen Allred felt a similar surge in visits to his mental health startup Tava Health.
Allred and his wife Cami started Tava Health in 2019 to create a platform that employers could tap so workers could see a therapist or psychiatrist virtually. The couple recognized that Utah ranks among the worst in the US for access to mental health care. In some parts of Utah, patients must drive an hour just to get to a clinic, yet as many as 25.5 percent of the population struggles with mental illness.
Tava’s January 2020 launch proved to be perfect timing. Last summer, 40 percent of US adults reported struggling with mental health or substance abuse, according to the Centers for Disease Control. Virtual visits on Tava Health doubled during its first year of 2020. Yet before the pandemic, doctors and therapists resisted the idea of telehealth for fear of missing the subtle body language cues of patients when face-to-face.
That mindset immediately changed with COVID and has been reinforced ever since. According to Allred, mental health patient outcomes are actually better with telehealth. When a person can meet on their phone or laptop, it takes away the hassle and challenges of attending appointments. No-show rates dropped to five percent with virtual visits, compared to the average 30 percent, he says.
Buoyed by $3 million from investors, Tava Health plans to expand beyond its 100 paying employers this year—most of which are in Utah—and its 100 therapists licensed in 45 states.
Despite the new interest in virtual doctor visits, the sector still faces challenges ahead. The pandemic forced the federal government to fan the flames of telehealth by reducing telehealth regulations, which limited who could be seen, where, for what, and at what cost. Yet those waivers expire at the year’s end.
Now there’s talk of returning to many of the original restrictions on which kinds of visits are eligible and which kinds of patients can tune in remotely.
And insurers, too, may be more inclined to roll back some of their initial pandemic generosity, which included waiving copays and covering more types of virtual visits. In some cases, doctors were getting paid the same amount for virtual visits as they were for in-person visits—which had previously been a barrier to the adoption of telehealth. SelectHealth, Utah’s largest health plan, is already rethinking benefits, reimbursement rates, and planning for stricter criteria on what qualifies for telehealth.
When it comes to mental health, Utah still has regulatory barriers that will limit virtual appointments. Utah is among many states that still bar out-of-state therapists from providing mental health care to its citizens without going through a cumbersome and expensive licensure process. Yet the state lacks the therapists to meet demand. “It’s a stupid law, and it’s outdated,” says Allred.
Therapists also get paid 20 percent to 30 percent less for virtual visits than they do in-person visits. “There is very little that you can’t do well virtually when it comes to mental health,” Allred says. “You’re not listening to a heartbeat or lungs.”
The Tava Health platform, courtesy of Tava Health
Remote monitoring, virtual reality, and automated visits are coming
Though, the ability to listen to heartbeats and lungs from afar may come to a home near you soon. Intermountain’s ConnectCare is exploring new technologies for remote patient monitoring within its hospital network.
During the height of the pandemic, Intermountain gave newly diagnosed COVID patients mini COVID kits that included pulse oximeters and other technologies so doctors could remotely track their condition at home. The result: a 50 percent reduction in return ER visits. A $200 kit prevented what could have become a three-day, $3,000 hospital stay.
“I spend more time talking about remote monitoring than anything,” says Palakanis. She says the hospital system is exploring at least 20 other conditions where such technology could be useful—mostly in cardiac and lung disease.
Lots of data—heart rate, electrocardiograms, blood pressure, blood oxygen levels, kidney function, and more—can now be measured through remote wearables and used by doctors to manage care offsite. Recognition technologies, too, are being developed to pinpoint voice, emotion, gesture, posture—which could add to a doctor’s evaluation of a patient. And telemedicine could reduce provider workloads, cut the need for hospital or clinic space, and labor-intensive data entry. It could be helpful for post-surgical check-ins, prenatal visits, health education, and medication management.
These new technologies coincide with patients who have gotten very comfortable with virtual doctor visits, according to an October survey by healthcare IT firm DrFirst. Patients reported that during virtual doctor visits, they surfed the web, texted, played video games, sipped “quarantinis,” or drove in the car. Some didn’t even get dressed.
A little patient etiquette might be in order, but most people prefer the comfort of an online waiting room to one inside of a clinic. And that’s good news for startups like Doxy.me, because widespread adoption of the technology presents new opportunities to innovate.
With no outside investors calling the shots at Doxy.me, Welch says he feels more autonomous and free to innovate: “We’re going to create the future of what we think telemedicine should be.”
A Charleston resource center for people experiencing homelessness uses telehealth to provide medical care to one of the state’s most vulnerable populations.
More than 4,000 people in the state of South Carolina are experiencing homelessness. In the Charleston area, there are more than 400 homeless people: veterans, seniors, individuals and families.
“It’s really hard to get out of homelessness,” said Marie Elana Roland, CEO of The Navigation Center.
People typically live in “a crisis mode,” Roland said, because it is very difficult to escape homelessness. But The Navigation Center, located in downtown Charleston at 529 Meeting Street, provides food, housing support, employment services, hygiene care, and medical care through telehealth with doctors from the Medical University of South Carolina.
“Telehealth is an amazing technology for us,” Roland said. “They can just walk in and meet with MUSC and start their diagnosis. It’s a way for them to start getting healthy, so that they can make the right decisions and the right choices for their next steps.”
Layne Walker, a medical student at MUSC, and the first director of operations at The Navigation Center, said with the help of student volunteers, and telehealth technology, doctors are able to treat a variety of patient complaints all without leaving their office at MUSC.
Using digital equipment including a stethoscope and otoscope, the healthcare provider located at MUSC can hear and see throughout the exam.
“It’s as if the provider was in the room,” Walker said.
Cristin Swords Adams, DO, MPH, and Assistant Professor for the MUSC Department of Family Medicine, said providing care through telehealth allows her to bring medical care to patients who might not otherwise seek out care.
“This is an often stigmatized and marginalized population and often there’s a lot of distrust with the medical system,” Adams said. “We’re providing this care at a place where they’ve already developed relationships and they have trust.”
The agency hopes to get the OK at its June commission meeting to post a second Report and Order on the program, which aims to boost telehealth adoption by funding broadband expansion projects.
– The Federal Communication Commission is ready to move forward with its Connected Care Pilot Program, which aims to help providers expand their telehealth networks through better broadband connectivity.
The FCC is working on a Second Report and Order for the program, which launched in April 2020 and selected 14 applications for funding this January. More than 200 applications were received during the application window for the $100 million program.
According to a report issued by the FCC in advance of its June 17 commission meeting, the agency’s second report will help clarify how it identifies eligible services and provide more details to applicants on funding commitments, reimbursement and other aspects of the program. It would also give the green light to those selected in the first round to launch their three-year projects.
“The Commission received more than 200 Pilot Program applications from many health care providers whose patients lack Internet connections sufficient to transmit a video visit or receive health care through connected care and providers who indicate that their systems and bandwidth are inadequate to carry the new and significantly increased loads,” the FCC said in its report. “The projects we expect to announce in the future, as well as those announced in January 2, will directly benefit thousands of low-income patients and veterans facing a wide variety of health challenges, such as diabetes, hypertension, stroke recovery, opioid dependency, high-risk pregnancy, pediatric heart disease, mental health conditions, and cancer. Through these projects, we will develop a better understanding of how the Universal Service Fund (USF or Fund) can help support the adoption of connected care services among patients and their health care providers.”
The effort marks a slow-and-steady approach from the FCC for this program, and a departure from how the agency launched and managed its COVID-19 Telehealth Program. That program quickly blew through its $200 million budget in 2020, funding some 540 programs, but faced criticism from lawmakers and others over vague requirements and rules and a lack of transparency.
The second round of the COVID-19 Telehealth Program launched in April, with $250 million in new funding from the Consolidated Appropriations Act of 2021 and a pledge from the FCC to be more thorough in screening and approving applicants. The window for applications closed on May 6, and the FCC has yet to announce any award winners.
With the COVID-19 Telehealth Program and the Connected Care Pilot Program, the agency is focused on funding and supporting projects across the country that allow providers to improve the framework upon which connected care is delivered. Telehealth advocates say these programs are crucial to improving access to care for underserved and rural populations.
The health system invested heavily last year in telehealth and remote patient monitoring technologies to solve problems of the present and set itself up for the future.
First, staff recognized a high percentage of patients with diabetes or hypertension, or both, had unhealthy blood pressure (BP) and blood glucose (BG or A1c) metrics. High A1c levels indicate that a person might be at risk for diabetes.
Staff took a measure of all HopeHealth patients in December 2020 with these two problems:
A1c < or = 9, 70%
A1c > or = 9 / untested, 27.8%
BP <130/80, 30.7%
BP <140/90, 64.9%
“These simple metrics have a ripple effect in rural areas,” said Sean E. Whitfield, system integration analyst at HopeHealth. “Lack of care opportunities due to transportation, limited primary care locations and inadequate income opportunities can send many patients running to the emergency department.
“The need for early intervention through remote patient monitoring is key to saving patient lives and preventing unnecessary ED visits. For this problem, we adopted a remote patient monitoring solution from FORA Telehealth,” Whitfield continued.
Second, HopeHealth’s supply of telehealth hardware was out of date and lacked clinical peripherals. These constraints made it impossible to offer a comprehensive exam remotely.
“In 2019, we could only provide 156 telehealth visits for nutrition education and psychiatry,” Whitfield recalled. “As HopeHealth serves more than 50,000 patients, significant gaps in care in most centers were obvious. For this problem, we chose the vendor IronBow Technologies and specifically their Clinic Telehealth platform.
“Because we were painfully aware of the patient barriers that keep them out of care, each of these problems required funding,” he said. “When an FCC telehealth grant opportunity arose with a pandemic looming, it was high time to enhance and upgrade our services.”
PROPOSAL
For the health system’s RPM solution, the goal was to have patients achieve healthy BP and BG metrics over a set amount of time, using the devices to track progress. This program uses a 3G-enabled blood pressure and blood glucose monitor and a web-based electronic health record.
“Whether through partnerships with hospital systems, school systems and more unique monitoring programs, telehealth is here to stay, and we are looking toward the future.”
Sean E. Whitfield, HopeHealth
“Each patient would be requested to check their BP and BG multiple times a day, such as after a meal, when they wake up and before bed,” Whitfield said. “The RPM device then automatically submits this data to the EHR with a subsequent clinical pharmacist notification. Gathering this much data allows for early intervention of medication dosage, nutrition and lifestyle stressors.”
The bulk of HopeHealth’s investment in telehealth hardware came in the form of carts outfitted with the following equipment:
High-definition monitor.
Intuitive touch panel.
Point-tilt-zoom high-definition camera.
JedMed Horus with a general view lens and otoscope lens.
Omnisteth digital stethoscope.
The goal, which focused on the pandemic, was to alleviate the need to reschedule patients due to physician exposures to COVID-19. With physicians out of the office for up to three weeks, a logistical nightmare could develop without telehealth, Whitfield said.
“Each appointment reschedules a backlog of visits. Patients begin to run out of medications, have healthcare events, and add to already overwhelmed EDs,” he explained. “Procuring such specialized equipment also allows exponential advancement in our telehealth offerings. Now physicians can see and hear a patient with a telehealth presenter operating the examination peripherals from any of our centers.”
This qualification on its own allows the completion of comprehensive visits such as annual wellness check-ups for adults and children, he added.
MARKETPLACE
There are many vendors of telemedicine technology and services on the health IT market today. Healthcare IT News recently compiled a comprehensive list of these vendors with detailed descriptions. To read this special report, click here.
MEETING THE CHALLENGE
HopeHealth’s remote patient monitoring program started with a bang after acquiring 375 devices with $423,645 in FCC grant funding. The project manager issued instruments to the staff at most care locations and then distributed them to patients.
“The patients we provided devices to were mainly low-income patients who would never usually have access to technology or information like this,” Whitfield noted. “We encouraged each patient to check their metrics multiple times a day, and the clinical pharmacists export the reports to the eClinicalWorks EHR. Most of the results go to the individual patient’s primary care physician for final review.”
When the pharmacist reviews concerning data, they create an alert to have the patients’ clinical team intervene immediately. As this program stabilizes, staff can begin developing programmatic structures for the RPM groups. The plan will include RPM as a part of regular patient visits enhanced by nutrition and lifestyle education.
The carts began service immediately for physicians affected by COVID-19. Dr. Joseph D. Hoyle contracted COVID-19 in the fall of 2020 and had the following experience.
“When I had COVID, my employer offered me the option to continue working,” he explained. “My patients appreciated getting to keep their appointments and see the rest of their medical home team and me. My staff managed the peripherals while I directed the camera. Our shared documentation process did not change.
“I knew I could rely on the in-office vital sign measurement, office processes and nursing interventions,” he said. “The medical assistant and nurse prepare the patient chart with a pre-visit encounter and then usually dedicate a room for the patients to rotate with privacy for these visits.”
In primary care, a personal relationship is essential to disease management and anticipatory guidance, he added.
“Telehealth has maintained my relationship with patients during times of great need or isolation,” he noted. “Over the last year, the fear of COVID-19 has made many patients hesitant toward in-person visits. However, telehealth has allowed us to maintain or even improve patients’ health who have been able to engage with the technologies or access a telephone.
“The necessity of using telehealth over the past year keeps me optimistic for enriching my career,” he continued. “I look forward to blending intuitive telehealth to overcome barriers in healthcare, access and quality. Over time my team and I [have] become more confident in deciding which patients and complaints we can assess comprehensively using telehealth to diagnose certain conditions virtually.”
Dr. Hoyle’s experience is just one example of how HopeHealth used the telehealth carts during the pandemic. Many of the providers had this same experience when they either had a potential exposure or contracted COVID-19, Whitfield noted. A few specialists who were practitioners of telehealth got a nice upgrade from the outdated hardware in circulation, he added.
RESULTS
Preliminary results for the RPM program have seen some positives for the first group of patients. In these five months spanning December 2020 to April 2021, data indicates an average of positive outcomes for all 375 patients:
A1c < or = 9, December 64%, April 67%, +3%
A1c > or untested, December 35.1%, April 33%, -2.1%
BP < 130/80, December 30.5%, April 31.8%, +1.3%
BP < 140/90, December 65.2%, April 66.5%, +0.3%
“These patients decreased their A1c values and reduced their blood pressure,” Whitfield noted. “Only time will tell if this becomes a trend, but these outcomes are promising. Such data is validation that RPM can be a driver of patients controlling and maintaining their healthcare over time, and information is truly powerful.
“Implementation of the new telehealth carts allowed us to increase our patient visits throughout 2020,” he continued. “In 2019, with our existing hardware, we saw 156 patients via telehealth out of 218,050 total encounters. In 2020, we were able to see 21,013 patients virtually, out of 234,527, successfully. Of the 21,013 encounters, 20% [were] accounted for via telehealth carts, and direct-to-patient software accounted for 80%.”
Each maintained appointment stopped the ripple effect and allowed for prescription refills, labs, procedures and fewer chances of an ED visit.
“As a federally qualified health center, a large part of what we do is keep patients in care so EDs can focus on more significant issues like COVID-19 and non-preventable emergencies,” he added.
USING FCC AWARD FUNDS
In 2020, HopeHealth was awarded $423,645 by the FCC’s telehealth grant program for remote monitoring equipment and telemedicine carts stationed at 10 clinic sites throughout four counties, so providers exposed to COVID-19 who are required to self-isolate can continue seeing patients, and patients that are most vulnerable to the virus can be seen at home via telehealth remote monitoring devices for care coordination and medical tracking.
“The FCC telehealth award funds went to hardware purchases only,” Whitfield explained. “We bought 375 BP/BG monitors and 16 telehealth carts. We successfully expanded our RPM program from around 10 patients to 385 in a matter of months. We are now capable of comprehensive telehealth visits in all 14 care locations, up from only five in 2019.
“Not only are we able to see more patients, we feel that these resources provide a new point of access for them,” he added. “Our ability to provide patients with devices and accommodate travel restrictions levels the playing field for many individuals and overcomes barriers to care.”
For HopeHealth as a whole, the health system now is an accessible telehealth provider in South Carolina, he said.
“Many new conversations and potential partnerships are on the rise,” he concluded. “The hardware, staff training and awareness have us looking at new ways to deliver healthcare. Whether through partnerships with hospital systems, school systems and more unique monitoring programs, telehealth is here to stay, and we are looking toward the future.”
MONCKS CORNER, S.C. (AP) — Santee Cooper is taking applications from companies that want to use its extra fiber and transmission lines to bring broadband internet to rural areas.
The state-owned utility said it has 1,200 miles of extra lines, many in the most rural areas of South Carolina that currently don’t have broadband access.
Santee Cooper won’t provide the service directly, but is asking companies that want to apply to offer broadband to visit its website.
The utility’s board agreed to the program last month after legislators passed a bill late in 2020 allowing the utility to join with private companies on the project.
Small, rural hospital continues to break new ground with state-of-the-art technology and award-winning patient care.
In the Intensive Care Unit (ICU), every second counts, no matter the hour or the day. Now, thanks to technology and partnerships, life-saving critical care is only the push of a button away for patients in our local ICU.
On May 6, Hampton Regional Medical Center (HRMC) cut the ribbon on its new Tele-ICU Unit. Through a partnership with the Medical University of South Carolina (MUSC) Health and Hicuity Health, HRMC is now able to provide advanced intensive care around the clock through the use of telemedicine technology.
Faced with challenges that include remote locations and a shortage of specialists and intensive healthcare providers, many rural hospitals are turning more and more to virtual tele-health to provide quality care for their rural populations, and HRMC has fully embraced this concept.
“We can now keep patients closer to home, with their families near, and still provide the critical care they need,” said Cam Ulmer, a Registered Nurse who helps oversee the program. “It has been a blessing for this hospital, and for the whole community. Just having the support of an Intensivist is huge.”
Located inside the hospital’s five-bed Intensive Care Unit are two fully equipped Hicuity Health rooms, complete with high-resolution cameras and monitors to enable healthcare providers at the bedside to communicate directly with advanced specialists that may be on the other side of the continent. For small hospitals that can’t afford to keep an Intensivist on staff, this technology will make it possible to keep sicker patients locally for longer.
May 21, 2021 — Two new bills introduced into Congress this week both aim to accelerate the rate at which quality broadband access reaches unserved and underserved Americans living in rural communities.
The Expanding Opportunities for Broadband Deployment Act introduced Thursday by Rep. G. K. Butterfield, D-N.C., seeks to repeal unnecessary eligibility requirements that prevent otherwise qualified internet service providers from participation in federal universal support programs designed to close broadband access gaps nationwide. Universal support programs are federally funded and operate on the belief that all Americans should have access to communications services.
The bipartisan Rural Broadband Financing Flexibility Act introduced on Tuesday by Sens. Maggie Hassan, D-N.H., and Shelley Moore Capito, R-W.V., aims at helping states, cities and town spur investment in rural broadband projects. The bill would provide state and local governments with new financing options for broadband projects, giving states and localities access to additional tools to invest in rural broadband.
Butterfield’s legislation will retire the eligible telecommunications carrier designation requirements, which, according to the NCTA, “unfairly prevent qualified ISPs from participating in federal universal support programs.” By removing the requirements, more service providers with a history of competently operating broadband networks will participate in the federally funded programs.
Ideally, this will spur competition among more competing internet service providers, who will all seek to bring internet service to underserved areas for the best quality and lowest prices.
Hassan’s and Moore’s bill would allow states to issue tax-exempt bonds in order to finance rural broadband projects. These bonds would be backed by the federal government, which would ensure repayment on the bonds, thereby making the purchasing of such assets a riskless investment. Additionally, the legislation would create a federal tax credit that states and localities could direct toward rural broadband projects.
“I’ve been pursuing every angle to ensure rural areas get reliable, affordable connectivity,” Capito said. “This legislation will provide additional funding opportunities for communities looking to invest in rural broadband. I’m proud to team up with Sen. Hassan again to reintroduce this legislation that will help close the digital divide in West Virginia and across rural America by incentivizing buildout and expanding financing options.”
New bills introduced in the House and Senate signal Congress’ intent to make telehealth flexibilities in Medicare and Medicaid permanent after the pandemic ends.
A pair of bills recently introduced in the House and Senate aim to ensure that a boom in telehealth use during the pandemic does not go away.
A House bill introduced Monday and a Senate bill introduced Tuesday both aim to make certain telehealth flexibilities permanent for Medicaid and Medicare beneficiaries.
“The pandemic has created challenges for everyone, but it’s also shown us that technology can provide safe and dependable communication between patients and their doctors,” said Rep. Jason Smith, R-Missouri, one of the co-sponsors of the House bill alongside Rep. Josh Gottenheimer, D-New Jersey. “Innovations including telehealth and audio-only capabilities will improve efficiency, reduce costs and increase access to healthcare providers.”
At the onset of the pandemic, the Centers for Medicare & Medicaid Services waived key barriers to telehealth use, enabling providers to offer audio-only telehealth services and ensuring that originating site requirements were removed. The new flexibility helped greatly expand the use of telehealth as providers could get Medicare reimbursement and help patients scared of going to the doctor’s office or hospital for fear of contracting COVID-19.
But the telehealth flexibilities will only last through the extent of the COVID-19 public health emergency, which will eventually lapse as the pandemic gets under control.
CMS officials have said that they need Congress’ help to make the flexibilities permanent.
The House’s Permanency for Audio-Only Telehealth Act would enable audio-only telehealth services for Medicare enrollees.
The legislation would also remove geographic and originating site restrictions to ensure that Medicare beneficiaries’ homes can be telehealth originating sites for audio-only services.
The Medical Group Management Association applauded the legislation.
“During the COVID-19 pandemic, audio-only visits have provided a lifeline to patients who are unable to attend visits in person or participate in telehealth visits due to lack of broadband access or necessary equipment to facilitate the visits,” said Anders Gilberg, MGMA’s senior vice president of government affairs.
The bill builds on similar legislation introduced in the House in March that would enable audio-only telehealth services for Medicare Advantage plans. Currently, providers can offer telehealth services under MA plans but only if they involve a video component.
Congress is not just looking at how to expand access to telehealth for Medicare.
Sens. Tom Carper, D-Delaware, and John Cornyn, R-Texas, introduced legislation on Tuesday that seeks to increase telehealth access for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, according to a report in Politico.
The legislation would require the Department of Health and Human Services (HHS) to give guidance to states to increase telehealth access for CHIP and Medicaid. This would include outlining what services can be reimbursed by telehealth.
The bipartisan nature of both the House and Senate legislation underscores the likelihood they could get through Congress and signed into law.
HHS Secretary Xavier Becerra has repeatedly underscored the need for legislative help if the boom in telehealth wants to continue.
“COVID has taught us so much,” Becerra said during his confirmation hearing in February. If we don’t learn from COVID how telehealth can save lives then we are going to be in trouble.”
As the Lakelands slowly creeps out of the novel coronavirus pandemic, a task force in Greenwood County is looking to solve an infrastructure problem that was highlighted during the pandemic.
“We failed you, in that we did not have what you needed,” Sen. Billy Garrett told superintendents of each of Greenwood County’s three school districts. “This hit us, we’re going to fix that.”
Garrett was addressing the need for rural broadband internet access, a challenge that was even more transparent last year as schools transitioned to e-learning to avoid the person-to-person contact that could spread COVID-19.
On Monday, leaders of Greenwood from city and county government, the Upper Savannah Council of Governments, state legislators, and school administrators met at the Greenwood Genetic Center’s Curry Conference Center to hear from the state Office of Regulatory Staff about the state of broadband in South Carolina.
“The focus has shifted,” said Nanette Edwards, executive director of the Office of Regulatory Staff. “I’ve had folks tell me that they see access to the internet the same way you would have access to water, sewer, same way you’d have access to electric utility electric service.”
She said broadband is an area where state law does not have a lot of regulation, which has provided opportunities to meet the needs in communities.
“The focus now shifting to broadband and giving consumers the access they need for telework, telehealth, and most significantly for our education,” Edwards said.
The Office of Regulatory Staff is the state’s office that is working with rural communities to develop paths to building rural broadband infrastructure in the most needed areas. While broadband does not have its own office, Regulatory Staff employs a broadband coordinator, Jim Stritzinger, who gave a presentation to the task force.
Stritzinger’s connection with Greenwood goes back to late 2014 when he worked with former Greenwood Partnership Alliance CEO Heather Simmons Jones to establish Greenwood County as one of the first certified connected communities, he said.
Stritzinger said when looking at broadband an evaluation has to be made of three areas: access, adoption and use. He presented a number of maps to the task force showing broadband access and capabilities in the state using the 2015 minimum criteria of 25 Mbps download speed and 3 Mbps upload speed, the speed that it takes to stream a video without buffering.
Using that information, he identified 10 target areas representing about 36 square miles in Greenwood County where people live that do not have access to internet service.
“It’s not affordability, it doesn’t exist,” Stritzinger said.
Stritzinger said 556 similar target areas exist across the state.
He said the state has 35 internet service providers and praised one that was represented in the room. Stritzinger said WCTEL – whose CEO Jeff Wilson was in attendance — made a visionary move in 2008 to rebuild infrastructure in Abbeville County to make broadband fiber internet service available throughout the county.
Much of the southern parts of Greenwood County outside of Greenwood city limits are areas where there is no internet available.
“That means the people that live there have no choice for an ISP, candidly, there’s nothing there,” Stritzinger said.
Stritzinger said a lot of the data he obtains on internet speeds come from the Ookla Speed Test, a service available by website and mobile app that tests the speed of an internet connection.
He said the state will also see some federal money — $122 million — help with broadband initiatives. Charter Spectrum has been awarded a grant to expand broadband in the state as well as Elon Musk’s SpaceX Starlink program, a satellite-based internet provider.
Edwards said coordination is the biggest issue. The task force hopes to help with that.
“Our task force was formed in order to assess areas of Greenwood, McCormick, in portions of adjacent counties which needed broadband coverage,” Garrett said.
Garrett said Upper Savannah COG will help with writing grants the group may want to seek.
“I’m really heartened by what Vision Greenwood has done,” Stritzinger said.
Vision Greenwood, formerly GPA’s Foundation for a Greater Greenwood, has been coordinating broadband taskforce meetings even before the organization is ready to fully introduce itself.
“Vision Greenwood is all about community development, providing leadership to enhance the quality of life in Greenwood through long-term vision and strategic community development initiatives,” Kay Self, executive director of Vision Greenwood, said. “It’s a continuation of some of the efforts that we’ve started for the past 10 years. Bringing in new fresh ideas, taking on some of the gaps and shortfalls in our community.”
Collaboration is the key to success for Vision Greenwood and its broadband efforts.
“Let’s work together,” Self said. “We are going to need your help to collaborate and make this happen for our community.”
Contact staff writer James Hicks at [email protected] or on Twitter @jameshicks3.
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
