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November/December 2018

mHealth Update: The Need Grows to Increase Access to Virtual Care
By Rebecca Hafner-Fogarty, MD, MBA
For The Record
Vol. 30 No. 10 P. 33

Earlier this summer, the Federal Communications Commission (FCC) announced the $100 million Connected Care Pilot Program (CCPP) to support telehealth and telemedicine programs for underserved populations. Specifically, the program focuses on supporting low-income, remote, and veteran populations, with the bulk of the funding earmarked for improving rural access to broadband internet.

While this program is certainly a sign of brighter times to come, alone it is not enough to resolve the pain points of access to health care in remote parts of the country.

Is Broadband the Answer?
Given the sheer number of localities where broadband cable will never be physically or economically feasible, focusing solely on broadband won't fully resolve the patient access problem. While the FCC and other government agencies are making strides toward addressing this issue, to truly effect change and expand the reach of virtual care, they must broaden their efforts to include satellite broadband and mobile data networks (4G and 5G), among others.

According to a 2018 FCC report, at the end of 2016 more than 24 million Americans lacked fixed terrestrial broadband at speeds of 25 Mbps/3 Mbps. Aimed at improving broadband access, the CCPP is likely to produce some improvement to virtual care and health care access, but only for a minority of patients.

Virtual Care and Patient Access
We all know that health care access is not equal in the United States. While the CCPP focuses primarily on rural and remote areas, there are myriad factors that play significant roles in health status, including transportation and specialty care access. In fact, the average patient has to wait as long as 52 days to get an appointment with a new physician in Boston, which is the longest wait period in the country.

According to the American Hospital Association, telemedicine programs are associated with reduced hospital stays and better patient survival rates. Telemedicine can also enhance efficiency, facilitating higher productivity and thus reducing appointment wait times. What's more, according to a whitepaper from the Rural Broadband Association, telehealth lowers costs for both medical providers and rural patients, reducing transportation costs on average by $5,718, lost wages by $3,431, and hospital costs by $20,841.

Cost savings were likewise evidenced by the Veterans Health Administration's (VHA) recent remote patient monitoring program, which cost only $1,600 per patient compared with more than $13,000 per patient for VHA's home-based primary services.

If the industry is serious about lowering health care costs and improving care quality and patient access, government agencies, legislators, and physicians must embrace technologies that can help meet these goals.

The Net Neutrality Debate
In December 2017, the FCC decided to overturn its net neutrality rules. The implications of this ruling on virtual care remain to be seen. What's clear, however, is that the health care industry increasingly relies on the internet to support numerous technologies and services. When it comes to virtual care, success hinges on maintaining a basic and equal level of access to telecommunications.

By banning paid prioritization, net neutrality rules allowed providers to use virtual care and telemedicine technology to help support equal health care access for patients. Repealing it essentially revokes standardized access for all consumers, including those seeking health care online.

There is also a risk of significant ripple effects from this deregulation. Small health care organizations such as rural critical access hospitals, independent clinics and solo providers, and inner-city community clinics often have limited resources. These vital safety net providers and the patients they serve will potentially be disproportionately affected by the overturn of net neutrality.

While technology is a vital tool for 21st century health care, it's important to remember that this is still very much a human endeavor, and changes to technology impact real people.

Broadening Access
In the next iteration of this guidance, the FCC needs to broaden its view of what remote access means. Expanding access to health care should include focusing on a wider range of tactics. Broadband in the 20th century opened the door to using technology to improve access to care, which was an important step. Today, technologies such as satellite broadband, mobile data, and cloud technologies are critical to supporting 21st century health care access. This should be a top priority not only for the FCC but also for all levels of government.

Providers should look beyond traditional, broadband-based video as the primary means of delivering remote care. Other, lower-bandwidth virtual care solutions offer improved access for patients and providers. Buffered video, real-time chat, and modern-day store-and-forward applications, such as algorithmic, evidence-based online adaptive interviews, can improve access to high-quality care even in the absence of high-speed broadband.

The FCC deserves kudos for pursuing the CCPP as a means of expanding access to both health care and high-speed broadband. However, if the industry is committed to realizing the potential of virtual care to help achieve the quadruple aim, it must be flexible. All stakeholders—government, telecommunications companies, and providers—must work together to explore and embrace innovations designed to improve health care delivery for everyone.

— Rebecca Hafner-Fogarty, MD, MBA, is senior vice president of policy and strategy for Zipnosis.