Over the past four years, the Federal Communications Commission has made headlines over voting to repeal net neutrality rules, has pushed Congress for more funding for broadband expansion and has faced the ire of lawmakers who said the FCC should do more to assist low-income Americans to have digital access. The agency's chairman Ajit Pai, a Republican appointed to the bipartisan FCC in 2011 by President Barack Obama, has also been vocal about the role telehealth played during the pandemic.
Modern Healthcare technology reporter Jessica Kim Cohen caught up with Pai to talk about challenges and opportunities for the agency's connected healthcare work in 2021, closing the digital divide for internet access—increasingly considered a social determinant of health—and why he hopes to continue working on telehealth issues. The following is an edited transcript.
Modern Healthcare: We've seen a rapid rise in telehealth use amid COVID-19. From your vantage point, what was the main barrier to mass adoption of telehealth before the pandemic? What's the main challenge today?
Pai: With respect to the gaps that were in existence before the pandemic, certainly, the lack of reliable broadband access was one. Broadband access has been improving over the last couple of years—it's not yet where we want it to be, but we're getting there. We've made substantial reforms to our Rural Health Care Program (a program that helps rural healthcare providers purchase broadband and telecommunications services). The program, which has been in existence since 1997, had a flat budget of $400 million for decades. We increased that early in my administration, and we also indexed it for inflation. Currently, it's about $605 million. We also urged Congress to give us funding for a COVID-19 Telehealth Program (which Congress allocated $200 million and another $250 million in funding for as part of its pandemic relief bills). Hopefully, the funding for telehealth programs run by the FCC won't be a limiting step going forward.
Another challenge that I heard quite often when I visited healthcare facilities is the requirement for medical professionals to be licensed in each state where they're offering service. One of the things that's been very helpful, I think, is the Veterans Affairs Department. The VA, thanks to a federal rule from a couple of years ago, has broken down that barrier. They're using telehealth across state lines and in a really powerful way. So, hopefully, we can have a more robust conversation in the halls of Congress about breaking down that particular barrier for other providers. It's one thing to have connectivity, but if you can't apply that connectivity because of a licensing restriction, patients and practitioners are going to be worse off.
MH: As healthcare continues to move toward virtual care, some healthcare executives have said they're really starting to consider internet access as a social determinant of health. How have you seen internet access—or lack thereof—affecting health outcomes?
Pai: They're increasingly related. Early on, we established a relationship with the National Cancer Institute to map the intersection of those two things for cancer patients in rural Appalachia, mapping the rates of cancer along with access to broadband, or lack thereof. That started a conversation about how we can make sure that broadband was available to everybody for the purpose of telehealth. I think it's increasingly a factor in determining whether or not patients have access to care, especially now during the pandemic.
MH: How can the FCC and the private sector, including hospitals, work together to address the so-called "digital divide"?
Pai: One thing that would be fantastic for everybody involved to do would be to collaborate on some of the FCC's broadband initiatives. For example, we recently finished what we call our Rural Digital Opportunity Fund Phase 1 auction. That delivered $9 billion to connect millions of American homes in unserved area (to high-speed fixed broadband service). Ideally, in some of these rural communities, there might be a community hospital that could benefit from that broadband as well. Hospitals that are in some of these communities where we're supporting the construction of broadband networks could get involved to work with the broadband providers who won funds from the FCC—they could essentially say, "look, you're already building out to these 50 homes in this rural community, we want to talk about building the fiber line and extending the reach of your network so that we can do telehealth." That would be very powerful.
MH: FCC on Friday announced 14 pilot projects selected to receive a collective $26.6 million from the agency's Connected Care Pilot Program, which helps cover broadband costs for telehealth projects that deliver services to patients outside of the hospital setting. How do you expect to see findings from this pilot inform future activities at the FCC?
Pai: If it's successful, and I certainly hope it will be, my vision for the future is for Congress to give the FCC more authority and funding to transform its healthcare programs. Currently, our Rural Health Care Program focuses on the connectivity needs of bricks-and-mortar facilities. But I think the future is so bright when it comes to wireless technologies—there's no limits to the types of telehealth applications we could support. The Connected Care Pilot Program recognizes that the model of healthcare delivery is becoming inverted, with care being delivered wherever the patient happens to be, and that requires wireless broadband access. Wireless broadband access could support "internet of things" applications to help care teams intervene before a diabetes patient's problems materialize into emergencies or post-operative remote monitoring of child transplant patients. I hope that this pilot is successful with the 14 pilot projects, so that we can move forward for many more facilities across the country.
MH: I also wanted to ask about 5G, the newest generation of wireless internet. What do you think the shift to 5G will mean for hospitals?
Pai: We don't know exactly what the killer apps—so to speak—for 5G will be in the healthcare space, but I think they could be substantial, because we're effectively removing bandwidth limitations from previous wireless technologies as a constraint on connected care innovation. It could mean high-resolution, very low-latency 5G service that allows patients to be seen and treated remotely. It could mean augmented and virtual reality that allows medical school students to be trained in a way that's inconceivable today. I believe the combination of 5G with adjacent technologies like artificial intelligence and machine learning will transform healthcare delivery. Already, there are some academic institutions and startups working on taking some of the datasets that are out there—for example, for cancer patients—and, with 5G, analyzing patient information very quickly to figure out how to make sense of it and whether it fits a certain pattern. I think that is going to be exceptionally powerful.
MH: In November, you announced plans to step down from your post as FCC chairman Jan. 20. What's next for you?
Pai: I'm still finishing the sprint, so I haven't given too much concrete thought as to what comes next. I can say with certainty that I will yet again be letting my parents down and not going to medical school. They are both physicians—or they were physicians, until they retired recently—and I think they still held out a little bit of hope that after this FCC gig was up, I might take the MCAT and take the plunge. (Laughs.) But more seriously, I'm not sure what will come next. I do hope that it will give me an opportunity to work on telehealth issues. This is something I truly believe in.
I've told the story before, but I remember very keenly as a child in rural Kansas, my father, who was a urologist, getting up—sometimes before dawn—and driving 45 minutes to towns that were even smaller than ours, and the next day he might drive 45 minutes more, because there simply weren't any specialists in those towns. To be able to play a part at the FCC, and hopefully after the FCC, in leveraging the power of technology to deliver better access and outcomes to people who really need the help—that would be tremendously rewarding. I hope that is something that continues after I leave the agency.
