“PCC is proud to partner with SCTA on this important request for telehealth legislation.” Kathy Schwarting, PCC CEO
Charleston, S.C. (Mar. 15, 2021) — The South Carolina Telehealth Alliance (SCTA) and Palmetto Care Connections (PCC) released a letter (PDF) signed by 25 of South Carolina’s major health care systems and associations asking the South Carolina General Assembly to make health insurance coverage for telehealth permanent beyond the COVID-19 public health emergency. Telehealth refers to a broad scope of health care services, including clinical care, which is delivered remotely, often through a secure online video conference between the health care provider at their office and the patient at home.
The letter calls for legislation that would require health insurance payers to continue covering health care delivered virtually, regardless of where a patient is located in South Carolina or the type of provider providing the service. The SCTA also released an accompanying video of patient testimonials, showcasing the immense value telehealth brings to the citizens of South Carolina.
“Thanks to the leadership and investment of our legislative leaders, coupled with sustained collaboration across health systems, South Carolina has become a leader in the nation in using technology to extend health care across our state,” said Dr. James McElligott, Executive Medical Director of MUSC’s Center for Telehealth and Co-Chair of the SCTA. “Yet there is so much more to do to achieve our mission to provide equitable access to care to all South Carolinians. It is time to solidify telehealth as a foundational element of our health care system by removing inconsistent reimbursement and freeing our care providers to move care out of the office and into the lives of their patients.”
According to the SCTA, prior to the pandemic, some insurers only covered telehealth visits conducted between two clinical sites and restricted that coverage to certain provider types (e.g., physician, nurse practitioner). The lack of reimbursement and variation in payer policies prevented widescale telehealth adoption. This all changed in 2020. During the public health emergency, public and private health insurance payers eased restrictions on telehealth provider types and patient sites, which in turn dramatically increased patient access to primary care, mental health, and specialty services. This was especially true for patients living in rural communities.
“Before the COVID-19 pandemic, rural health care providers could not provide services directly to their patients via telehealth and get paid,” said Kathy Schwarting, Chief Executive Officer of PCC and Co-Chair of the SCTA. “Loosened regulations now allow both rural health clinics and federally qualified health centers to provide direct to consumer care virtually. We cannot go back to where we were before the pandemic and expect to meet the needs of our rural citizens.”
South Carolina has received national recognition for its programs, but despite this the Center for Connected Health Policy indicates it is one of the last states in the country without telehealth insurance coverage legislation in place. In the letter, the organizations note health care access for patients may be lost if immediate and swift legislative action is not taken: “If we do not advocate for major insurance payers to extend temporary telehealth policies, health care providers and patients will lose this critical tool in addressing health care needs across our state.”
The SCTA is a collaboration of health systems, primary and specialty care providers, state agencies, and other shared-mission support organizations that work together to improve the lives of all South Carolinians through telehealth. In recognition of this collaboration, the American Telemedicine Association awarded the SCTA its President’s Award for Transformation in Healthcare Delivery in 2019. The SCTA includes close to 600 connected care sites throughout the state and is administratively headquartered at the MUSC Center for Telehealth, one of only two Telehealth Centers of Excellence in the nation.
Established in 2010, PCC is a non-profit organization that provides technology, broadband, and telehealth support services to health care providers in rural and underserved areas of South Carolina. PCC leads South Carolina’s broadband consortium which facilitates broadband connections throughout the state. PCC co-chairs the South Carolina Telehealth Alliance, along with the Medical University of South Carolina, partnering with health care organizations and providers to improve health care access and delivery for all South Carolinians.
The Center for Connected Health Policy (CCHP) has released a new updated telehealth billing guide as a follow up to its 2020 billing guide to provide a helpful tool for healthcare entities trying to navigate the complexities of billing for telehealth and virtually delivered services. Policy changes during the COVID-19 Public Health Emergency (PHE) have only made telehealth billing rules more nuanced. The updated billing guide addresses whether or not there is reimbursement for telehealth both generally and/or during the PHE, as well as how to correctly bill for a telehealth encounter, which is one of the most common policy questions CCHP receives as the National Telehealth Policy Resource Center (NTRC – P). Further complicating the billing process is the need to understand whether current rules are only applicable during the pandemic as well as the fact that payer policies continue to vary from payer to payer. For example, policies that apply to a Medicare beneficiary remain different than those that apply to a state Medicaid enrollee or to patients that have private insurance.
Payment is not guaranteed for any type of visit, even during the temporary PHE flexibilities, whether due to frequency limitations, diagnosis code used, or the specifics of when and what the payer will cover. This guide provides a starting point on how to bill a telehealth encounter for eligible practitioners in a practice or facility, including: • Applicable requirements during 2021 • Requirements only during the PHE • Clarifications related to what may occur after then PHE ends The focus of this billing guide is primarily on fee-for-service Medicare and provides an example of one state Medicaid program, California. Most of the descriptions and definitions used throughout the report are from the Centers for Medicare and Medicaid Services (CMS). The guide takes the reader through: • Medicare rules for originating and distant sites, • PHE exceptions, • Application of the appropriate Place of Service code, modifiers and revenue codes. In addition, the updated 2021 billing guide highlights: • California Medicaid (Medi-Cal) policy in call out boxes including the program’s definition of an originating and distant site as well as synchronous and asynchronous store-and-forward telecommunications systems. • Billing basics for CMS’ communication technology-based services (CTBS), including remote evaluations and virtual check-ins, remote physiologic monitoring, electronic interprofessional consultations, and online digital evaluation services. • Service codes for principal care management, chronic care management and transitional care management • Various billing tips to keep in mind At the end of the guide, eight patient examples are provided that highlight common scenarios that would utilize the coding procedures outlined throughout the billing guide. The examples present a patient scenario (for example, a synchronous telehealth visit with an established patient who is covered by Medicare), and then shows how a biller would code the visit that occurred within the billing form.
On February 25th 2021, the Federal Communications Commission (FCC) adopted, through a unanimous vote, the establishment of the Emergency Broadband Benefit Program, which is a $3.2 billion federally funded effort to increase internet accessibility and affordability to underserved communities throughout the country.
The program seeks to assist households struggling during the pandemic to virtually connect to vital services, such as healthcare and education services, through monthly discounts for broadband service – up to $50 a month, or $75 a month for those on Tribal lands. Eligible households will also be provided discounts on computers or tablets of up to $100. Eligibility is based upon participation in existing broadband provider low-income or pandemic relief programs, Lifeline subscribers, Pell grant recipients, households with children receiving free and reduced-price school meals, and those that have lost employment and income over the past year.
The FCC Acting Chairwoman Jessica Rosenworcel announced that the program should be open by late April of this year. For more details, access the FCC press release.
MARION, S.C. – Congressman Tom Rice announced he is calling for more rural broadband investment.
In a letter to business owners, Rice said he joined 72 colleagues in sending a bipartisan letter to the President Joe Biden’s administration urging them to include investment in rural broadband in any infrastructure proposal.
“Infrastructure has been a top priority since arriving in Washington,” Rice said. “Many people in our district, and across our nation, lack sufficient broadband infrastructure. Internet connectivity is now more important than ever. In the 21st Century, high-speed broadband is no longer a luxury amenity.”
More students are using e-learning and families are increasingly reliant on the internet for everyday items, he said.
“Rural broadband has become an essential service for families and businesses to succeed,” Rice said. “This is why I have also joined the Rural Broadband Caucus. I look forward to working together toward practical solutions that bridge the digital divide across our nation.”
Marion County state delegates Sen. Kent Williams and Rep. Lucas joined officials from Horry Telephone Cooperative back in November on announcing its expansion serving parts of Marion County.
Gresham and Britton’s Neck communities are now supported through a $1.5 million grant from the South Carolina Broadband Infrastructure Program. HTC is matching the investment.
Officials said more than 400 homes will get broadband access.
A group of House Democrats on Thursday introduced the Leading Infrastructure For Tomorrow’s America Act (LIFT America Act), legislation that would invest almost $94 billion to expand access to broadband internet to underserved communities.
The bill would allocate $80 billion to deploy high-speed broadband nationwide by funding connections to unserved and underserved areas in rural, suburban and urban parts of the country. It would also allocate $5 billion for a new low-interest financing program for broadband infrastructure, and $9.3 billion to programs that help broadband affordability and equity.
The funds represent an expansion of the bill’s previous version introduced in May 2019, which allocated $40 billion for broadband deployment, $5 billion in low-interest infrastructure financing and aimed to expand access to high-speed internet to 98% of the country.
Dive Insight:
The legislation also contains provisions to fight climate change, protect the environment and invest in healthcare infrastructure, but the investment in broadband internet is particularly timely as the country marks one year of remote work, education and medical appointments amid the pandemic. The past year has amplified the growing digital divide, highlighting the urgent need for elected leaders to invest in equitable service.
One way the federal government will support low-income residents is through the Federal Communications Commission’s (FCC) Emergency Broadband Benefit program, which would receive $6 billion to provide a discount of up to $50 a month on broadband for eligible households. The FCC officially established the program late last month, having previously relied on the underutilized Lifeline program last year.
The bill would also focus on distributing funds to deploy broadband in underserved areas, an issue the FCC has tried to get under control after its Broadband Deployment Reports were criticized for vastly overstating service in some areas. Congress tried to find a legislative fix when it passed the Broadband DATA Act last year, directing the FCC to collect more granular data from wired, fixed-wireless, satellite and mobile broadband providers.
But the FCC suggested it may take until 2022 for new maps to be available, drawing a furious response from Republicans on the House Energy and Commerce Committee, who said in a letter that inaccurate mapping “would create additional delays to broadband deployment for millions of Americans.”
Under the LIFT America Act, the FCC would distribute $60 billion of the funds through a competitive bidding process and allocate the rest to states to fund broadband deployment processes of their own. It would also prohibit state governments from enforcing laws that prevent local governments, cooperative and public-private partnerships from delivering their own broadband service. Municipally run internet has gained in popularity in some cities, but often been stymied by state-level legislation blocking it.
In a Facebook post, House Majority Whip Rep. James Clyburn, D-SC, said internet access “will have the same dramatic impact on rural communities as the rural electrification efforts in the last century.” And with the pandemic heightening the importance of remote operations and living arrangements outside cities, experts say it is important to deploy broadband as widely as possible.
“I think there’s going to be people moving out of the big urban areas in the U.S. and looking for places to live that are less crowded, that have good connectivity,” said Jane Coffin, senior vice president of Internet Growth at the Internet Society, a nonprofit that advocates for improved internet access. “Every mayor should be right now building out an open network to get as many people connected at better prices.”
Last year, a few months after the start of the COVID-19 pandemic, U.S. Rep. Jim Clyburn, D-S.C., tried to pass a bill that would have provided rural communities across the country with affordable high-speed internet to help with remote schooling and work.
But with a Republican majority in the Senate, the House majority whip’s bill was stymied.
Now, with a Democratic majority in both chambers, Clyburn reintroduced the bill as the Accessible, Affordable Internet for All Act on March 11. It authorizes over $94 billion to ensure both underserved and unserved communities have affordable high-speed internet access.
Clyburn told The Post and Courier the measure will be particularly helpful for rural South Carolinians, including telehealth.
“Broadband is the one thing that can change the character of almost any community,” Clyburn said. “We want to make broadband accessible and affordable for every home in America. And this deal will do that.”
With Sen. Amy Klobuchar, D-Minnesota, introducing companion legislation in the Senate, the bill will likely be carried across the finish line.
“When we invest in broadband infrastructure, we invest in opportunity for all Americans,” Klobuchar said in a media statement. “In 2021, we should be able to bring high-speed internet to every family in America — regardless of their zip code.”
Clyburn has long pushed to address broadband deficits and formed a task force in Congress to specifically focus on the issue last year. In 2020, he also managed to get every member of South Carolina’s congressional delegation to sign a letter saying the issue should be made a priority.
But the bill didn’t see movement, even as the pandemic underscored the need for internet access.
Clyburn said his Republican colleagues from South Carolina support the bill, but he is unsure what they’ll do when the bill comes to the floor.
“They’re all for it,” Clyburn said. “But that’s not saying they’re all going to vote for it.”
Clyburn’s bill calls for:
$80 billion to deploy secure and resilient broadband infrastructure for communities nationwide.
$5 billion over five years for low-interest financing of broadband deployment.
$6 billion for the recently established Emergency Broadband Benefit, which provides a $50 monthly discount on internet plans for low-income Americans anywhere in the country, or $75 for consumers on tribal lands.
$1 billion to establish two new grant programs, which will help Americans build digital skills.
$2 billion for the Emergency Connectivity Fund, which provides for home internet for students or mobile hotspots.
The Accessible, Affordable Internet for All Act is the latest in several legislative pushes the longtime congressman has made in recent weeks as he capitalizes on the Democratic majority in Washington, D.C., and utilizes his relationship with President Joe Biden to bring his bills across the finish line.
“Now, we have some semblance of authority and power in the House and we have the votes in the Senate for it to become law,” Clyburn said. “And we got a person in the White House to sign it. So you might hear some giddiness in my voice.”
The digital divide fuels and is fueled by other leading social determinants of health, ultimately having an impact on patient wellness and health equity.
– As healthcare continues to lean on technological innovations, a new social determinant of health is coming to the forefront: the digital divide.
The digital divide is the chasm between those who have access to technologies and the digital literacy to work them, and those who don’t. In healthcare, the digital divide can lead to disparities in patient portal adoption, telehealth care access, or ability to utilize patient-facing practice management software, like online appointment schedulers.
The question around the digital divide in healthcare is not new. When the Centers for Medicare & Medicaid Services (CMS) put patient portal adoption as a key metric in the EHR Incentive Programs, healthcare organizations lamented an older population that wasn’t ready to use the technology.
A digital divide was splitting patient engagement strategies into those for the old and for the young, with many clinicians creating protocol that catered to generational differences.
In more recent years, healthcare experts have learned that the digital divide is more nuanced than that. Some older adults may be excited to utilize telehealth, while a younger, potentially low-income, patient might not have the infrastructure to support it.
Population health leaders are starting to look into the digital divide and where it is leading to health inequities and ultimately health disparities. In uncovering those issues, experts can craft better multimodal patient engagement strategies account for equity.
Below, PatientEngagementHIT outlines where the digital divide has proven a challenge and how it has become a key social determinant of health.
Telehealth disparities create care access gulf
Perhaps most prominently, the digital divide has forced a stark disparity in telehealth adoption and use.
Telehealth saw its heyday during the COVID-19 pandemic, when healthcare providers had to shut their doors to non-urgent healthcare. Telehealth proved an essential way to maintain chronic disease management for high-risk patients.
But that adoption was not equal across different populations. Much like coronavirus case counts, there were stark racial health disparities in pandemic-era telehealth use and adoption.
In September, a study in the Journal of the American Medical Informatics Associationfound that Black patients were four times more likely than White patients to access the emergency department, not telehealth, during the pandemic’s initial surge.
Older Black and Hispanic patients used telehealth at significantly lower rates than their White and Asian counterparts, and social determinants of health and structural inequity are likely the culprits.
For example, language barriers strongly dissuaded patients from accessing telehealth, the researchers said. Additionally, traditionally underserved patients without a usual source of care may have been more used to accessing the ED, or less able to have an established provider with whom they could pursue telehealth.
Separate data suggested that this digital divide, like other social determinants of health, had an impact on patient health and wellness. An Urban Institute report showed telehealth care access disparities falling along racial lines. Those disparities coincided with high rates of unmet medical needs among those already in poor health and those with public health insurance coverage.
Those patients wanted a telehealth visit but could not receive one, suggesting that the amount patients were accessing telehealth still was not enough, the survey showed.
“As the pandemic stretches on, it is important to ensure that everyone can access needed care,” Mona Shah, senior program officer at the Robert Wood Johnson Foundation, said in a statement. “Those left behind by telehealth are, in many cases, people who need care most urgently.”
Poor Broadband Creates Rural Digital Divide
The digital divide exists outside of telehealth and racial health disparities. Poor broadband, which refers to the infrastructure that supports any digital health tool, acutely impacts individuals living in rural areas.
In 2017, the American Medical Informatics Association (AMIA) asserted broadband is a key social determinant of health, largely because of its role in deepening the digital divide.
Also in 2017, AMIA’s journal published a study showing that poor broadband limited patient portal adoption. At the time, patient portal adoption in Ohio, which has both rural and urban regions, hung at around 30 percent, likely because a whopping one-third of patients reported broadband issues.
According to the North Carolina Broadband Infrastructure Office, there are four key barriers currently limiting broadband access and exacerbating the digital divide:
Broadband subscription cost
Broadband device, such as digital router, cost
Perceived lack of relevance or necessity in an individual’s life
Low digital health literacy
The former two barriers need policy intervention, the NC Broadband Infrastructure Office asserted. State and federal legislation can create mechanisms to improve broadband affordability, drive equity in digital health access, and make digital tools more accessible.
The latter two barriers will require a more concerted public education effort, the NC Broadband Infrastructure Office stated.
And as healthcare works to improve digital health literacy among patients, it has started to employ digital health navigators to fill in the blanks in the near-term.
Addressing digital health literacy
Data has confirmed that low digital health literacy—defined by the World Health Organization as the ability to seek, assess, and make use of health information via electronic media—perpetuates digital health inequity.
In February 2021, Florida Atlantic University found that limited access to virtual health information deepened the digital divide. Older, non-White people face more barriers in accessing digital health information than younger, White people, the institution reported.
That limited access to education both perpetuates and is perpetuated by the digital divide, with poor digital literacy begetting more digital literacy problems, the researchers added.
“Currently, digital health technology development is outpacing parallel efforts to conquer the digital health divide, which also has important implications for helping older adults get registered for the COVID-19 vaccine,” Ruth Tappen, EdD, RN, FAAN, lead author and Christine E. Lynn Eminent Scholar FAU’s Christine E. Lynn College of Nursing, said in a statement.
“Portals that allow patients access to their electronic health records, decision aids that prepare patients to discuss options with their providers, making telehealth appointments with providers and so forth, needlessly, though unintentionally, excludes, marginalizes, and disenfranchises those who are older, have low incomes, have low health literacy, and/or are members of minority groups,” Tappen continued.
Patient navigation is proving a critical tool in combatting this digital health literacy, and subsequent digital divide, problem.
At Nemours Children’s Health, which has heavily utilized health IT as part of its care management strategies and ramped that up during the pandemic, patient navigators were instrumental.
Alongside the rest of the industry, Nemours saw COVID-19 reveal a steep digital divide that kept some populations from engaging with its virtual care access and patient education options as much as others.
“During that time, we realized that in order to scale up to this extent, we needed to make sure that the patients were ready on the other end. And it was clear they were not,” Gina Altieri, Nemours executive vice president and enterprise chief communications officer, said in an interview with PatientEngagementHIT.
“They had no idea how to download the app. They had no idea how to make sure that their internet connection was appropriate.”
Altieri said the digital divide impacts two types of patients: those without devices or adequate infrastructure support, like broadband, and those without the digital health literacy necessary to engage with virtual tools.
At this early stage, most organizations, like Nemours, can only begin to address digital health literacy, which is no easy feat. Clinicians are already overburdened with integrating virtual care access themselves, making it far too onerous to ask them to walk their patients through a telehealth visit or engaging with the patient portal.
Nemours took advantage of a number of staffers whose jobs no longer existed in a pandemic world—someone who operates the front desk, for example—and reengaged those workers as digital health navigators.
“We said, ‘Okay, your job is to get the patient and family ready for their telehealth visit,’” Altieri said. “And hundreds of people at Nemours, in a sense, volunteered to do this.”
These digital navigators acted like a patient’s waiting room, helping them to work through digital forms or troubleshoot connectivity issues so that the healthcare experience was smooth for both the patient and the provider.
“Navigators really felt like they were contributing in a very big way,” Altieri continued. “Families were very appreciative of the handholding and the help that they were getting to get the care that they needed for their child because they were nervous through this whole thing.”
The digital divide is not a new problem, but when the pandemic emphasized the need for remote digital patient engagement and care access options, it became a notable one. The healthcare industry is keenly aware of already underserved populations falling further through the cracks, and the digital divide threatens that.
The current ad hoc solutions to poor digital health literacy and digital health access likely will not sustain true health equity. Rather, a multifaceted social determinants of health strategy, plus technology investments, will be critical.
After all, the digital divide is interrelated with other key social determinants of health, like race, income, or geographic location. As efforts continue on those fronts, accounting for the digital health access problems beleaguering already disadvantaged populations will be essential.
Charter Communications Inc. has announced plans to deliver gigabit high-speed broadband to approximately 98,600 unserved South Carolina small businesses and homes, including properties in Bamberg County.
Today, 60% of Bamberg County’s more than 14,000 residents cannot access high-speed broadband.
As a result of Charter’s investment in South Carolina, an additional FCC-estimated 2,853 Bamberg County homes and small businesses will have access to gigabit connections from Spectrum Internet.
More than $362 million will be invested in South Carolina, which includes an expected private investment of at least $250 million by Charter and more than $112 million in support won by Charter in the FCC’s Rural Digital Opportunity auction. Aiken Electric, CarolinaConnect partner to bring high-speed internet to rural areas Local Aiken Electric, CarolinaConnect partner to bring high-speed internet to rural areas
The effort is part of the company’s recently announced expected investment of approximately $5 billion — offset by $1.2 billion in RDOF support — to expand Charter’s network to what the FCC estimates to be more than 1 million homes and small businesses in lower-density, mostly rural communities across 24 states that do not have access to broadband service of at least 25/3 Mbps.
The new initiative is in addition to Charter’s existing network expansion.
Four US senators called on the Biden administration Thursday to establish a “21st century definition of high-speed broadband” of 100Mbps both upstream and downstream. This would be a big upgrade over the Federal Communications Commission broadband standard of 25Mbps downstream and 3Mbps upstream, which was established in 2015 and never updated by former President Trump’s FCC chair, Ajit Pai.
Today’s letter was sent to FCC Acting Chairwoman Jessica Rosenworcel and other federal officials by two Democrats, one independent who caucuses with Democrats, and one Republican. Noting that “the pandemic has reinforced the importance of high-speed broadband and underscored the cost of the persistent digital divide in our country,” they wrote:
Going forward, we should make every effort to spend limited federal dollars on broadband networks capable of providing sufficient download and upload speeds and quality, including low latency, high reliability, and low network jitter, for modern and emerging uses, like two-way videoconferencing, telehealth, remote learning, health IoT, and smart grid applications. Our goal for new deployment should be symmetrical speeds of 100 megabits per second (Mbps), allowing for limited variation when dictated by geography, topography, or unreasonable cost.
“We should also insist that new networks supported with federal funds meet this higher standard, with limited exceptions for truly hard-to-reach locations,” the senators wrote later in the letter. “For years, we have seen billions in taxpayer dollars subsidize network deployments that are outdated as soon as they are complete, lacking in capacity and failing to replace inadequate broadband infrastructure.”
The letter was written by Sens. Michael Bennet (D-Colo.), Angus King (I-Maine), Rob Portman (R-Ohio), and Joe Manchin (D-W.Va.). In addition to Rosenworcel, it was sent to Secretary of Commerce Gina Raimondo, Secretary of Agriculture Tom Vilsack, and Director of the National Economic Council Brian Deese.
“Ask any senior who connects with their physician via telemedicine, any farmer hoping to unlock the benefits of precision agriculture, any student who receives livestreamed instruction, or any family where both parents telework and multiple children are remote learning, and they will tell you that many networks fail to come close to ‘high-speed’ in the year 2021,” they wrote. “For any of these functions, upload speeds far greater than 3Mbps are particularly critical. These challenges will not end with the pandemic.”
Rosenworcel pushed for higher speeds
Rosenworcel already supports a standard above the FCC’s current one. “With so many of our nation’s providers rolling out gigabit service, it’s time for the FCC to adjust its baseline upward, too,” she said in April 2020, calling for a 100Mbps download standard and an upload standard that’s higher than 3Mbps. “At present, our standard [for uploads] is 3 megabits per second,” she said at the time. “But this asymmetrical approach is dated. We need to recognize that with extraordinary changes in data processing and cloud storage, upload speeds should be rethought.”
The FCC standard is important for the commission’s annual broadband deployment report that determines how many Americans are “unserved” and grades the country’s progress toward universal availability. Adopting a higher speed standard would make it more likely that the FCC will find that broadband deployment is not happening fast enough and take more aggressive action to speed up deployment.
The FCC isn’t as active as it could be right now because there is a 2-2 split between Democrats and Republicans. President Joe Biden can fix that by nominating a new Democratic commissioner, but he hasn’t done so yet.
100Mbps a big upgrade for uploads
Going from 25/3Mbps to 100/100Mbps would be an especially large upgrade on the upload side. Today’s offerings from cable companies would not meet the 100Mbps threshold for uploads, as even gigabit-download cable plans from Comcast and Charter come with only 35Mbps upload speeds. The cable industry for years has been promising faster upload speeds powered by upgrades to DOCSIS, the Data Over Cable Service Interface Specification. But cable’s speeds are still unbalanced, providing much greater download speeds than upload speeds.
By contrast, AT&T and Verizon’s fastest fiber plans come with 940Mbps download speeds and 880Mbps upload speeds. Even the cheaper, lower-tier plans offered by fiber-to-the-home ISPs meet the senators’ proposed 100/100Mbps standard.
Cable is far more widespread than fiber in the US. The eight biggest cable companies combined have 72.8 million Internet subscribers, according to Leichtman Research Group. The top eight wireline phone companies have 33 million Internet subscribers, but that includes both fiber-to-the-home and DSL, and those copper-line DSL networks are severely outdated and poorly maintained.
A serious commitment to symmetrical 100Mbps broadband may require a lot more fiber construction across the US. The senators’ letter didn’t quite take a fiber-or-bust stand, but they do want federal funding in rural areas to support higher upload speeds than what you normally get with cable:
While we recognize that in truly hard-to-reach areas, we need to be flexible in order to reach unserved Americans, we should strive to ensure that all members of a typical family can use these applications simultaneously. There is no reason federal funding to rural areas should not support the type of speeds used by households in typical well-served urban and suburban areas (e.g., according to speedtest.net’s January 2021 analysis, average service is currently 180Mbps download/65Mbps upload with 24 millisecond latency.
The senators are also frustrated by differing standards across agencies. “We now have multiple definitions across federal agencies for what constitutes an area as served with broadband, resulting in a patchwork without one consistent standard for broadband,” they wrote. “For example, the FCC defines high-speed broadband as download speeds of up to 25 megabits per second and upload speeds of up to 3 megabits per second (25/3Mbps). Alternatively, the US Department of Agriculture (USDA) defines it as just 10/1Mbps.”
FCC deployment data
The FCC is already supporting networks faster than the 25/3Mbps standard. The commission’s Rural Digital Opportunity Fund (RDOF) tentatively awarded $9.2 billion over 10 years to 180 entities to deploy broadband to 5.2 million unserved homes and businesses. The FCC said that “99.7 percent of these locations will be receiving broadband with speeds of at least 100/20Mbps, with an overwhelming majority (over 85 percent) getting gigabit-speed broadband.” The funding is going to a mix of cable, fiber, and fixed wireless providers, plus SpaceX’s Starlink satellite network.
The most recent FCC broadband deployment report said that, as of year-end 2019, 95.6 percent of Americans had access to fixed broadband with speeds of at least 25Mbps downstream and 3Mbps upstream. Deployment at higher speeds is more limited, especially in rural and tribal areas. For example, the report said that 250/25Mbps speeds are available to 87.2 percent of people nationwide, 55.6 percent of people in rural areas, and 49.6 percent of tribal residents.
Those data points likely undercount the number of unserved Americans because the FCC lets ISPs count an entire census block as served even if it can serve just one home in the block. The commission plans to collect geospatial maps from ISPs to make the data more accurate.
By Bill Snyder| March 4, 2021 at 1:55 PM CST – Updated March 4 at 6:11 PM
GULFPORT, Miss. (WLOX) – Federal Communications Commissioner Brendan Carr was in South Mississippi Thursday, working with state community college leaders and Southern District PSC Commissioner Dane Maxwell on creating more internet-broadband based jobs for that expanding industry.
“How do we have the workforce in place to build out the next generation of internet infrastructure which is 5G which is the fastest newest service?” Carr said. “Right now, we can almost double the amount of tower tech workers. We can hire 20,000 almost overnight.”
The current pool is 27,000 tower technicians and other broadband/internet based employees. He and others would like to expand that workforce through Mississippi’s community college system.
“We came up with an idea because we have such good community colleges, so we put them together and put everybody together and build a curriculum,” Maxwell said. “Build an apprentice program and get them trained and get them out.”
When they are out, they go to businesses like Millerco, a company based here in South Mississippi that has nine locations in four states.
“People don’t realize it takes a lot to make your cell phone work. It’s not magic and it’s not pixie dust. It’s hard, tough, dangerous work that these tower techs are doing and nationwide we’re looking at needing to fill about 20,000 positions,” said Jordyn Ladner, Millerco operations manager.
Carr and others also toured MGCCC’s Harrison County Campus and other areas of the Coast.
“We need to make sure that every community in this country has a fair shot and next gen internet,” Carr added. “It’s so critical whether it’s for distance learning, telehealth, or working remotely.”
Palmetto Care Connections (PCC) is the telehealth network for South Carolina that offers telehealth support services to rural and underserved health care providers.
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