Senators and healthcare IT experts on Thursday raised concern that many Americans won't be able to benefit from virtual care services without affordable high-speed internet access across the country, and it's unclear where the bill should go.
Telehealth proved essential for helping patients access healthcare services in the early days of the COVID-19 pandemic.
"The digital divide is standing in our way of connecting all Americans to this vital service," said Sen. Ben Ray Luján (D-N.M.), chair of the Senate's Subcommittee on Communications, Media and Broadband, during Thursday's hearing. "We must connect every American to high-quality, affordable, resilient broadband—without it, the current patterns of inequity will continue to grow."
Broadband access has been a focus of the Biden administration, which in July announced $65 billion for broadband infrastructure as part of the Infrastructure Investment and Jobs Act.
Luján added that broadband is often more expensive in rural areas, and cited statics from the Federal Communications Commission that found 14.5 million people live in areas with broadband that doesn't meet the agency's speed benchmark. That's from a 2019 report, the most recent FCC analysis on the subject.
Brendan Carr, a Republican commissioner at the FCC and a witness at the hearing, said he wants the agency to continue to auction spectrum, distribute funds earmarked for rural broadband to telecommunications companies and coordinate more closely with other agencies putting money toward broadband infrastructure, like the Agriculture, Commerce and Treasury Departments.
He also voiced support for a bill introduced by Sens. Roger Wicker (R-Miss.), Shelley Moore Capito (R-W.V.) and Todd Young (R-Ind.), which would direct the FCC to study whether the agency could collect fees from technology companies like Google and Netflix to support its Universal Service Fund, which subsidizes telecom and broadband services in low-income and rural areas.
The Universal Service Fund is funded currently through fees on telecom companies.
Collecting fees from big tech companies could be a "much more fair way" of funding the Universal Service Fund, Carr told Wicker at the hearing, since those companies benefit "to the tune of trillions of dollars" from investments into broadband expansion. "They should start contributing their fair share," he said.
The Universal Service Fund funds various programs, including the FCC's Rural Health Care Program, which helps rural healthcare providers purchase broadband services. That's separate from the Connected Care Pilot Program, a pilot Carr kicked off at the FCC last year, which focuses on connecting providers to patients at home.
Adding contributors to the Universal Service Fund—such as big tech companies—could help ensure the fund has enough money to support the demand for its service, according to Carr.
Telehealth utilization has been dropping from the sky-high rates seen last year, as doctor's offices have reopened. In May, telehealth accounted for 11% of all visits—lower than 50% of visits, as reported in April 2020, but still higher than the less than 1% of visits that telehealth represented before the pandemic, according to an analysis the Chartis Group and Kythera Labs.
Healthcare executive have said they expect telehealth to remain part of their services after the COVID-19 pandemic subsides, particularly among younger patients who appreciate the convenience and in rural areas where the closest provider can be miles away. Some executives have estimated telehealth could ultimately account for between 10% to 30% of their total visits.
But purchasing high-speed internet services, even if is available, can be expensive—posing a challenge for small healthcare providers in rural areas.
"We've come into … small critical-access facilities who cite monthly fees of up to $15,000 for broadband access," said Deanna Larson, president of Avel eCARE—a clinician-to-clinician telehealth business formerly part of Avera Health in Sioux Falls, South Dakota. "That's an incredible amount of money when you're that size."
Funds from FCC programs have helped to defray those costs for critical-access hospitals they've worked with, she said.
Dr. Sterling Ransone, Jr., president of the American Academy of Family Physicians and a practicing family physician in Virginia, called on Congress to invest in efforts to set up "universal access to affordable broadband services" for patients and providers, referring to broadband access as a social determinant of health.
Ransone noted that while the Rural Health Care Program has helped providers obtain high-speed internet connections, it hasn't addressed whether patients at home are able to afford internet—not to mention computers, tablets and digital health technologies. He also said set-up and subscription fees charged by telehealth companies can be "prohibitive" for some small practices.
"Congress should ensure that small practices are adequately supported," such as by making reimbursement for such services eligible as part of FCC programs, Ransone said.