Earlier this year, the Broadband Opportunity Council — an interagency council created by President Obama — published a request for comment seeking ideas from stakeholders on ways the government can better support broadband adoption. Separately, the Federal Communications Commission in February adopted new rules for regulating the Internet that will increase oversight of mobile and fixed broadband providers. In addition, FCC currently is looking at ways to reform and modernize programs under the universal service, which aims to ensure all Americans have access to communications services, such as broadband.
Despite these recent efforts, research shows that about 17% of the U.S. population, or about 55 million people, lack access to advanced broadband.
In California, rural parts of the state are lobbying providers and policymakers to ensure adequate backup service so interruptions in broadband access don’t wreak havoc with health care delivery and other vital services that have become dependent on Internet access.
“We’ve had two major outages in the past 14 months that really had significant impacts on our communities, including problems with providing health care,” said Trish Steel, chair of the Broadband Alliance of Mendocino.
“Many of our health care services are underserved already with less than state-of-the-art broadband capacity, and then when the service is disrupted and there’s no redundant service to back it up, there are real problems,” Steel said.
The Mendocino alliance contends maps showing areas of coverage are often not accurate and that they rarely indicate backup provisions, known in the industry as “redundant service.”
The first major outage on the North Coast — a tall piece of machinery took out a cable strung on poles in August last year — interrupted access for three days for a large part of Mendocino County. Two months ago, vandals cut cables above ground, causing a 20-hour outage.
“For hospitals and clinics and doctor’s offices, it basically puts them out of business,” said Steel, a representative of the North Bay/North Coast Broadband Consortium.
The consortium is working on a two-year, $250,000 grant from the California Public Utilities Commission to improve broadband service in rural parts of four counties — Marin, Mendocino, Napa and Sonoma.
Rep. Jared Huffman (D-San Rafael) urged FCC to ensure that rural residents are not harmed as telecom companies replace old copper networks with next-generation technology.
“My constituents have had their health, safety and livelihood compromised by the neglect of copper networks,” Huffman wrote in a letter to FCC officials.
Benefits for Health Care
FCC’s National Broadband Plan noted that broadband access has the potential to improve health outcomes, address a looming physician shortage and reduce health disparities across ethnic groups, while controlling costs.
The federal government currently is pushing the adoption of electronic health records and is embarking on efforts to improve interoperability. Providers seeking to electronically exchange health data need to have access to broadband connections that can support the transfer of large health files.
In addition, lawmakers and several health care groups are seeking to increase access to telehealth services, which require both the provider and the patient to have Internet access.
Shirley Bloomfield — CEO of NTCA, the Rural Broadband Association — called broadband “the wave of the future,” noting that it stands to be an “equalizer in health care unlike anything we have seen in a long time.”
She noted, “Mental health care is a perfect example of where broadband can be an easy way to use technology” because it removes the stigma of visiting a mental health clinic and eliminates the burden of having to travel long distances to see a provider.
Connectivity Gaps, Barriers Among Health Care Providers
Although little research has been conducted to determine health care providers’ broadband access needs, FCC’s National Broadband Plan found about 1% — or an estimated 3,600 — of small provider practices across the U.S. face a broadband connectivity gap. However, that percentage rises to 7% when looking at just rural areas.
Danielle King, rural broadband policy group coordinator at the Center for Rural Strategies, said that as the U.S. moves toward digital mediums and technology, her organization has found that some populations have been left behind with “low broadband access or no access at all.”
Medium and large providers also face barriers to broadband connections, as they tend to require costly dedicated Internet access that support higher download speeds. Pricing largely depends on geography.
The report found that several federally funded providers — such as federally qualified health centers, rural health clinics and critical access hospitals — are located in areas without mass-market broadband services, meaning they must pay for the higher-cost DIA services if they wish to have Internet access.
A CMS spokesperson noted that providers who are eligible to participate in the meaningful use program and are located in a region where broadband is unavailable may apply for a hardship exemption.
Federal Efforts To Improve Broadband Access
The federal government has undertaken several initiatives to help improve health care providers’ access to telecommunications and broadband services.
FCC has established four programs within the Universal Service Fund to implement the Telecommunications Act of 1996 and expand access to advanced communications services, including the Rural Health Care Program. The program offers three types of federal subsidies, the:
- Telecommunications Fund, which subsidizes the rates rural providers pay for telecommunications services;
- Internet Access Fund, which provides a 25% flat discount on monthly Internet access for rural providers and a 50% discount for providers in states that are completely rural; and
- Pilot Program, which provides five years of support for costs of advanced telecommunications and information services for rural and urban providers.
In 2012, FCC created the Healthcare Connect Fund to support Internet access and broadband infrastructure.
In March 2014, FCC created the Connect2Health task force to examine ways that stakeholders can “accelerate the adoption of health care technologies by leveraging broadband and other next-gen communications services.” The task force currently is working to build connectivity maps for each state that show the distribution of broadband and population health. The first map was launched in August for Virginia.
Ways To Reform Broadband Efforts
In a Health Affairs blog post, the authors noted that several of the recommendations outlined in FCC’s National Broadband Plan have yet to be implemented. The authors, some of whom worked on the original FCC plan, offered three recommendations for FCC that would help to strengthen the program without the use of additional funding:
Simplify the application process to provide greater clarity on the amount of support providers could receive and align the program’s outcome metrics with those of other government agencies that providers already use, such as CMS’ accountable care organizations and the meaningful use program;
Expand program eligibility to include more health care providers, such as those who work in long-term care facilities, and for-profit providers, which often are the sole provider in rural areas; and
Publish updated reports and funding guidance to ensure that the program keeps pace with the changing broadband environment and the needs of providers.
Bloomfield said FCC program reforms are underway. She noted that her organization agrees with FCC’s updated definition of advanced broadband but cautioned that FCC’s universal service standards and funds need to be altered “to match that definition.”
Meanwhile, King said, “In terms of the health care industry and rural Americans, we need to make sure that there are local, state and national efforts to bring equitable Internet access and deployment that addresses the needs of rural communities.” She added, “There shouldn’t be a one-size-fits-all broadband” solution.
— Additional reporting by George Lauer, California Healthline features editor