House Small Business Subcommittee on Health and Technology Hearing
Federal Information & News Dispatch, Inc. |
INTRODUCTION
Good morning, my name is
Among its 25,000 plus customers spread across 9,300 square miles of rural northwest
Broadband is proving to be a great equalizer for rural America. This is especially true for health care needs in rural areas, as high-speed broadband helps healthcare providers serve patients more efficiently and effectively. One of
To be clear upfront, broadband isn't only used and useful for telemedicine. It has become essential to the very provision of healthcare in any form or fashion, as doctors' offices, clinics, and hospitals need broadband to: backup systems at offsite data centers; connect with insurance companies to check eligibility; offer electronic billing; conduct research; and host educational webinars. Further, some hospitals provide IT services to other facilities and thereby reduce hardware and software costs.
But even with these many benefits for the provision of healthcare generally, it is clear that broadband can play a special role in rural areas by enabling greater telemedicine functionality and helping residents overcome the challenges of distance that make so many tasks more expensive and time consuming. Telemedicine means a patient in need of an immediate mental health consultation who lives hours from the nearest facility can have an instant connection to their psychologist through a telemedicine platform at their local hospital. Another patient may need digital x-ray scans sent to a far-away physician who can assess how their fracture is progressing. These are only a few of examples of the telemedicine possibilities that robust broadband enables.
To help promote greater adoption of advanced telemedicine capabilities,
Healthcare professionals generally need three significant barriers removed before they can adopt and implement telemedicine: 1) robust broadband capability, 2) money for hardware and software, and 3) staff who know how to use the technology. Insurance reimbursement may present a major barrier to in-home telemedicine, but availability and adoption of technology present other obstacles, not only in rural
While barriers to in-home telemedicine remain, healthcare providers are still able to use numerous other exciting and innovative applications that help them provide better care to patients. For example, thanks to robust, wired broadband that enables high-speed Wi-Fi at the rural health clinics in our service territory, soon hospitals will be able to deploy robots that can effectively transport a doctor stationed at a hospital to a far-away rural area. Patients who visit the clinic are able to interact with the doctor through the robot, which is equipped to conduct diagnostic testing. The same Wi-Fi is helpful to doctors who travel to clinics and need to use their mobile devices while on the premises to communicate with other health care professionals.
Currently, licensing of doctors is handled at the state level and, as such, oftentimes providers cannot serve patients across state lines, which greatly limits the use and/or implementation of virtual telemedicine visits. The TELE-MED Act (H.R. 3077), introduced by Representatives
Government programs provide some assistance. For example, the American Recovery and Reinvestment Act sought to promote use of electronic health records (EHRs) through
USF can help fill telemedicine deployment and adoption gaps through two of its four components. The USF High Cost fund supports the actual rural networks that
Finally,
USDA RURAL UTILITIES SERVICE
RUS Role in Telemedicine and Rural Telecom Deployment
RUS also plays a crucial role in rural broadband deployment through its telecom loan portfolio that finances network upgrades and deployments in rural areas. RUS has been lending for broadband-capable plant since the early 1990s. RUS lending and
Unfortunately, the success, momentum, and economic development achieved from the RUS's telecommunication programs were put at risk as a result of the regulatory uncertainty arising out of USF reforms that are discussed in greater detail below. It will be all the more important to continue providing RUS with the resources it needs to lend to the rural telecom industry as demand for financing will inevitably increase when reforms are improved and regulatory certainty is restored. Once again, telemedicine efforts will be for naught if robust broadband-capable networks aren't there in rural areas to support those efforts or if the broadband services offered on those networks are not affordable and upgraded over time.
THE USF HIGH COST FUND AND RURAL HEALTH CARE PROGRAM
USF Rural Health Care Program
The High Cost and Rural Health Care components of USF have a symbiotic relationship - the
The RHC is available to non-profit and public healthcare providers located in an
Pilot Program participants include The
The
As I have noted earlier, telemedicine simply cannot be implemented without an underlying robust, wired broadband network. Though demand for faster broadband is expected to increase dramatically in the near future, RUS received only 29 broadband loan program applications for rural network loans in fiscal years 2011-2013, compared to 130 in the first three full years of the program. n3 Why would an experienced lender such as RUS want for customers when demand for networks is high? Look no further than the state of rural telecom cost recovery mechanisms.
For example, the
Despite the fact that the
Nearly three years after a "Transformation" order, small, rate-of-return providers still await an updated cost recovery mechanism that will provide sufficient and predictable support for the simple act of responding to consumer demand for better broadband. Meanwhile, the
The broadband revolution presents major opportunities for small businesses to innovate and grow, but the business (or entrepreneur with an idea) must have broadband access to take full advantage. Markets will ensure many consumers realize the full benefits of innovation at the lowest possible prices, but in rural areas there are often no such markets to speak of. Though small, rural providers have been leaders in broadband investment even under the current statutory and regulatory regime, further law and policy changes will be necessary to ensure high cost rural areas both become and remain served even as providers also edge broadband out into unserved areas. We cannot hope to realize the full benefits of broadband for the provision of healthcare generally, and telemedicine more specifically in rural areas, if outdated rules deny support for broadband-capable network investments or the threat of adverse changes to these USF rules create uncertainty in making the decisions to undertake such long-term investments. Sufficient and predictable USF support that provides recovery for both the initial costs of installing a rural broadband network and the ongoing costs of operating and upgrading that network over time must be seen as a prerequisite to any successful efforts in telemedicine.
CONCLUSION
Telemedicine already offers health care providers numerous ways to better serve patients, and many more exciting innovations are on the horizon. The desire for advanced telemedicine already exists, but now we must supply - and then sustain - the robust broadband capability, funding, and education to spur increased adoption of the services across the country.
Rural America will not realize the promise of telemedicine without a broadband-oriented USF that offers carriers the regulatory certainty needed to make network investments. Support through the
n1
n2 Id.
n3 U.S.
n4 See US House letter led by Representative Gardner and
Read this original document at: http://smbiz.house.gov/UploadedFiles/7-31-2014_Basgall_final_testimony.pdf
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House Small Business Subcommittee on Health and Technology Hearing
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