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POLITICO: Broadband: The other big obstacle to telemedicine

POLITICO eHealth: Broadband: The other big obstacle to telemedicine
By David Pittman
July 31, 2014 

A lack of good Internet connections is nearly as big an obstacle to increasing telemedicine as the lack of Medicare funding for the services, witnesses told a congressional hearing Thursday.
Many hospitals and doctors’ offices across the country lack broadband or fiber-optic cabling with the necessary bandwidth to use certain forms of telemedicine, said Maggie Basgall of Lenora, Kan.’s Nex-Tech, a broadband-service provider for rural areas in the upper Midwest. Many patients lack wireless capabilities and are still reliant on dial-up Internet.
“Without that, they can’t do in-home telemedicine,” Basgall said following a House Small Business Health and Technology Subcommittee hearing.
Although there are 46 telemedicine-related bills pending before Congress, the hearing was just the second devoted to the issue this year. A bill is expected to be brought to the floor in 2015.
“What our purpose was today, and I think we’ve done it, was to start a discussion,” said Rep. Chris Collins, chairman of the subcommittee. “If we don’t start the discussion at some point, we’re seeing a hodge-podge of things move forward, state by state.”
Rep. Blaine Luetkemeyer (R-Mo.) said the lack of broadband was the biggest impediment to telemedicine after the lack of federal reimbursement.
“I live in a rural part of Missouri, and I’m barely in a broadband area myself,” Luetkemeyer said. “I know that there are a lot of areas within my own district that may not have broadband.”

Basgall singled out for blame the FCC’s quantile regression analysis, which changed the ways its $4.5 billion Universal Service Fund program doled out support to small telecommunications providers.

Rural broadband providers like Nex-Tech felt they could no longer reliably predict if they would be able to recover the costs of network upgrades and therefore stopped seeking loans to build faster networks, she said.
The FCC scrapped the changes earlier this year and is considering a replacement.

“I think [the FCC] realized it wasn’t predictable,” Basgall said. “People can’t build infrastructure when they’re trying to follow a model that doesn’t give them predictable support.”

Karen Rheuban, director of the University of Virginia’s Center for Telehealth, said the FCC’s Rural Health Care Program, which provides discounts to rural providers seeking broadband, has gone unfulfilled because of its “onerous, complex application process, and statutory exclusions to eligibility that do not always align with health disparities.”

Broadband wasn’t the only topic during Thursday’s hearing. Witnesses spoke about Medicare’s restrictive reimbursement policies, which are limited to live, face-to-face interactions delivered from health care facilities located outside of metropolitan areas. As a result, Medicare paid a mere $12 million for telemedicine services last year.

“Common sense says we need to move this forward,” Collins said. “If a doctor doesn’t get paid, they’re not going to participate.”

Rheuban also mentioned a cumbersome licensure model for providers who wish to treat patients in other states. Anti-kickback laws limit physicians from making referrals to places where they own an interest, such as telemedicine equipment they provided for another’s use.

Patient privacy laws and bureaucratic informed consent procedures are also barriers, Rheuban said.


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