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The American Telemedicine Association sent a letter to the Federal Communications Commission July 10 pointedly questioning the status of an agency rulemaking to create a new $400 million program aimed at connecting rural health care providers to broadband.
The FCC voted to launch the rulemaking last July with the goal of expanding a three-year-old agency pilot program. The pilot program has been criticized for its restrictions on which entities can apply for funds and what those funds can be used for.
In the letter, ATA Chief Executive Officer Jonathan Linkous suggested that the agency's actions over the past year have raised more questions than answers about whether real reform will be achievable anytime soon.
He noted that it has been a year since the FCC opened the rulemaking; 16 months since it released its National Broadband Plan, which includes health care IT policy proposals; and eight months since the General Accountability Office issued a report criticizing the agency's management of the Rural Health Care Program.
“Despite the promises, the rhetoric, and the official criticism, a great silence has settled over the commission regarding these issues,” Linkous wrote. “Now, we also note the departure of every key professional staff from the commission involved in healthcare policy. It is deeply troubling to see that the commission is allotting practically no resources with no apparent plans to address the proposed rulemaking, the [National] Broadband Plan, or to respond to the GAO report.”
Linkous said that despite the FCC's goal of allocating up to $400 million annually as part of the program, only $80 million will be spent this year outside of a one-time pilot program commitment, according to the AMA's estimates.
Under the rulemaking in question, the FCC would increase the subsidies allocated under the Universal Service Fund for health care provider service costs from 25 percent to 50 percent and also cover 85 percent of the construction costs for new or upgraded broadband networks in areas with weak infrastructure for health IT. The funding for the program will come from the $8 billion Universal Service Fund (see previous article).
The FCC's Rural Health Care Program is one of the four programs that make up the Universal Service Fund. The program provides subsidies for telehealth and telemedicine—typically a combination of video-conferencing infrastructure and high-speed internet access—to enable doctors and patients in rural hospitals to access specialists in distant cities at affordable rates.
As detailed in its National Broadband Plan, the FCC wants to revamp federal programs to reimburse a wide array of health care providers for purchasing broadband services in any location, in addition to urban areas, where such purchases are unaffordable.
The notice of proposed rulemaking issued a year ago, however, came after the FCC conducted a study of accessibility to high-speed internet access service for health care providers, and found that about 3,600 small physician practices in the United States do not have sufficient access to broadband internet services to achieve “meaningful use” of electronic health records.
While practices with fewer than five doctors often are able to access broadband through services available in the commercial marketplace, the services typically are cost-prohibitive, according to the agency. For larger practices that need greater bandwidth, the costs for broadband access can be as much as $45,000.
“With the crisis America faces in healthcare, the commission's failure to take action is disturbing,” Linkous added in the letter to FCC Chairman Julius Genachowski. “We are now making this plea for the FCC to reach a decision in these matters quickly and to implement the approved changes without further delay.”
Though the FCC has yet to adopt the broader policy proposals outlined in the July 2010 NPRM, the agency has issued an interim rule allowing health care providers previously grandfathered under an old definition of “rural,” which was in place before July 2005, to continue to qualify for discounted services until the commissioners approve permanent rules governing their eligibility to participate in rural healthcare programs.
In an order and notice of proposed rulemaking released in June as part of Wireline Competition docket 02-60, the commission approved a “carve-out” for 235 health care providers so that they could continue to serve the rural regions they already serve.
Public comments will be accepted until July 27, with a reply comment deadline of Aug. 11 on whether to make certain grandfathered health care providers permanently eligible for discounted service under the universal service rural health care support mechanism.
When contacted, the FCC had no immediate comment on the AMA's letter.
By Paul Barbagallo
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