TELEMEDICINE: Feds Dropping Ball on Rural Health Care?
The future of Internet-based health care as a tool to improve rural care delivery will remain uncertain if the federal government continues its current handling of the issue, the Los Angeles Times reports. Critics claim that mismanagement of federal funds and other "policy missteps and red tape continue to pose significant obstacles to telemedicine's exploiting the stunning growth and influence of the Internet." Once "touted as one of the Internet's most compelling applications," Congress earmarked $400 million in the 1996 Telecommunications Act to establish a program that would help 22,000 rural medical centers across the nation obtain high-speed Internet access. But, that program, implemented by not-for-profit Universal Service Administrative Co. under the supervision of the FCC, has so far managed to distribute only $289,424 to a mere 68 of 452 applicants, "less than one-fifth of the annual $1.4 million cost of administering the program." Last year the program awarded no money "because of bureaucratic delays." Says John Linkous, executive director of the American Telemedicine Association, "I've never seen a program as badly run as this . . . [It] has been a total disaster" (Shiver, 9/19).
Strangled by Red Tape?
In addition to claiming that Universal Services Administrative Co. is mismanaging the contract, critics point to federal regulations as hindrances to the program's progress. According to Dr. Richard Ferrans of Louisiana State University Medical Center, "The program has been underfunded ... The paperwork burden for rural hospitals itself serves as a deterrent to those who would apply ... This program needs to be simplified [and] expanded." Ferrans adds that Medicare's refusal to cover telemedic services universally also poses a problem. "Medicare covers telemedicine only in some communities, and it also has a complicated 'fee-splitting' arrangement ... that poses 'ethical, legal and administrative concerns' and doesn't adequately pay doctors," he says. Finally, Ferrans points to unenforced telecommunications regulations, which grant hospitals a discounted rate for Internet usage. "Without low rates, rural hospitals will not participate [in telemedicine]. Many live on the edge of economic existence, and we must do what we can to protect them" (McKinney, Baton Rouge Advocate, 9/19).