The FCC today launched a proceeding on whether and how it could conduct a pilot program proposed by Commissioner Brendan Carr aimed at supporting the delivery of advanced telehealth services to low-income Americans.
The WC docket 18-213 notice of inquiry (NOI) adopted at today’s Commission meeting seeks comment on the goals of the pilot program and the FCC’s statutory authority for conducting the pilot; the design and budget for the pilot program; the application process for parties seeking funding; the types of telehealth pilot projects that should be funded; the eligibility criteria for participating health care providers, broadband service providers, and low-income consumers; the broadband services and other communications services and equipment that should be supported; support levels and methods for disbursing support; the duration of the pilot program; and appropriate metrics for assessing the effectiveness of pilot projects in achieving the program goals.
Funding for the $100 million pilot project would be in addition to the existing funding levels for pre-existing Universal Service Fund programs, Commissioner Carr said during a press conference after the meeting.
Although Commissioner Jessica Rosenworcel, the agency’s lone Democrat, voted in favor of the NOI, she was critical of the agency’s past actions that she said “damaged” low-income Americans who relied of the universal service Lifeline program.
She emphasized the need for better access to remote health care for many segments of the population who have been affected by FCC changes to the Lifeline program, including pregnant women in rural communities that lack obstetricians and hospitals with maternity wards; victims of domestic abuse; individuals affected by hurricanes and other natural disasters; homeless youth who identify as lesbian, gay, bisexual, or transgender; veterans; and senior citizens.
“[I]t is going to be hard to improve access to telemedicine when this agency simultaneously is pursuing policies that strand senior citizens without basic communications service,” she said.
“So before this agency decides to give out $100 million in grants for a new health care pilot program it has to answer for its actions. It has to recognize that it has destabilized communications services that millions of Americans rely on today. It cannot borrow from the authority of the Lifeline program for a new project without first reconciling the damage it has proposed to do to those who already depend on it,” Commissioner Rosenworcel said.
“To be clear, that does not undermine the good we propose here. The possibilities of improving care for rural Americans, low-income Americans, and let me end where I started — pregnant Americans — are real. But we have a lot to do before we make that happen — and I hope my colleagues will commit to rolling up their sleeves and working with me to do it,” she said.
In his separate statement, Commissioner Mike O’Rielly, who also supported the NOI, raised his own concerns about the proposed pilot program.
“My goal is to ensure that any new program is: legally sound; coordinated both within the universal service fund (USF) and with other agency programs to avoid duplication; cost-effective for consumers and businesses that would fund it; and accountable to the agency and the American public. This Notice of Inquiry does raise some concerns along those lines, which I will touch on briefly,” he said.
“First, I have been skeptical of the agency’s authority to conduct pilot programs, particularly those that involve beneficiaries, services, and equipment not already authorized by law. At a minimum, I suspect we may need to pare back the scope of any such pilot project as this. Devices and ambulances, just to name two, seem far out of bounds,” Commissioner O’Rielly said.
“Second, we must avoid duplicating other USF spending, such as funding connectivity in a community that may already be subsidized or targeted through the high-cost program,” he continued. “Third, any new program should complement — not replicate — the multitude of other, existing federal telehealth initiatives. The item is short on outlining and explaining what programs already exists. But, if healthcare agencies have expertise in patient monitoring and fund equipment or apps, we shouldn’t do the same. Instead, we must consider ways to sufficiently target our dollars to specific needs, like connectivity, and leverage our respective authority, capability, and funding.”
“Fourth, our telemedicine programs can significantly reduce expenses for other healthcare programs and entities, but the Commission is not able to recognize any of these savings. For example, it is well known that patient monitoring can help avoid emergency room visits and hospital re-admissions. We need to take a deep dive to understand the size of these savings and must conduct extensive coordination with other programs so those savings can be reinvested in our programs to minimize the impact on telephone ratepayers. USF must not be used as the tax collector for telemedicine. This is of particular interest to me and I intend to engage personally on this aspect,” Commissioner O’Rielly said.
“Fifth, and relatedly, having just substantially increased the Rural Health Care program cap, we must carefully consider the impact of additional spending on the consumers and businesses who would pay extra on their phone bills to support it. I have called for an overall cap on USF to ensure we discuss the benefits and tradeoffs whenever spending changes are contemplated. This must be part of our future actions,” he added.
“Finally, as with any USF program, I want to ensure that it is targeted to unserved — not underserved — areas; that the selection mechanism is efficient and technology neutral, like via reverse auctions rather than beauty contests; and that appropriate safeguards are put in place to deter waste, fraud, and abuse,” Commissioner O’Rielly said.
“For our purposes today, the NOI is a very wide-ranging presentation of many issues that need to be considered and is sufficiently broad to be worth my support. I thank Commissioner Carr for getting us to this point, but we both recognize much work lies ahead. I commit to rolling up my sleeves to address these matters and others, consistent with my principles, before any Notice of Proposed Rulemaking is considered,” he concluded.
Commissioner Carr noted that programs run by health care providers may be able to purchase equipment for patient monitoring but can still find funding patients’ broadband connections to be beyond their means. “So that might be one area where the FCC could help get more projects up and running,” he said.
“Limited broadband deployments in rural areas present another challenge. James, [a] Navy vet, said that he installed a consumer signal booster in his home so that he could get an LTE signal strong enough for his virtual visits to work. So promoting new deployments might be another benefit of our Pilot Program,” Commissioner Carr continued.
“There are also many Americans for whom the cost of a high-speed connection is out of reach. By targeting this Pilot to low-income patients, we can ensure that every community benefits from remote patient monitoring technologies,” he said.
Chairman Ajit Pai said, “Broadband-enabled telehealth services like these can significantly improve Americans’ health and reduce costs for patients and health care providers alike. But many low-income consumers, especially those in rural areas, lack access to affordable broadband and may not be able to realize these benefits. That’s why we’re launching an initiative to figure out how the FCC can support the delivery of connected care services to low-income Americans. Specifically, we’re exploring a program to promote the use of broadband-enabled telehealth services among low-income families and veterans, with a focus on services delivered directly to patients beyond the doors of brick-and-mortar health care facilities. We’re asking for public input on the goals of, and statutory authority for, this ‘Connected Care’ pilot program as well as how best to design the pilot program.”
Karen Rheuban, director of the University of Virginia’s Center for Technology, spoke at the FCC meeting in support of the pilot program.
Sen. Brian Schatz (D., Hawaii), the ranking minority member on the Senate communications, technology, innovation, and the Internet subcommittee, said, “I’ve seen firsthand how telemedicine can make it easier for patients to see their doctors, bring specialized care to more places, and literally save lives. I thank Commissioner Carr and the FCC for looking at new ways to extend the benefits of telehealth to more veterans and families who are still struggling to get the care they need.”
He noted that he has proposed the bipartisan CONNECT for Health Act, which would expand telehealth services covered by Medicare.
Jonathan Spalter, president and chief executive office of the U.S. Telecom Association, said, “In moving forward with a Connected Care Pilot Program, the FCC has once again signaled its support for equal digital opportunity for all Americans. Broadband-enabled telehealth services — supported by broadband innovators in every corner of the country — are a lifeline for rural Americans. USTelecom thanks Commissioner Carr for his leadership on this important topic.”
John Windhausen Jr., executive director of the Schools, Health & Libraries Broadband (SHLB) Coalition, said, “The idea of connected care is still in its infancy, yet it has enormous potential to help people across rural America — veterans and low-income patients in particular. That is why the SHLB Coalition called upon the FCC to provide a discount for the wireless broadband costs of providing remote home monitoring in our 2015 Petition for Rulemaking. The Connected Care Pilot Program could provide a unique opportunity for the FCC to collaborate with broadband providers, healthcare providers and other government agencies to ensure that low-income consumers and rural communities have low-cost, high-quality telemedicine services. The SHLB Coalition and its members look forward to working with the FCC to build up this program.” —Lynn Stanton, firstname.lastname@example.org