POWELL SEEKS MORE PARTICIPATION IN FCC'S TELEMEDICINE PROGRAM

While the 6-year-old program offers a $400 million annual cap, only $30.25 million in discounts were disbursed in its first 5 years (1997-2001). Demand for 2000 and 2001 averaged $14 million per year, meaning only 3.5% of possible discounts were disbursed in those funding years, FCC officials said. Only 1,194 rural health care providers out of nearly 8,300 potential applicants received support in 2001. The program is “underutilized… and that means that it needs a lot of examination on how we qualify people for the program, how the applications are handled” and how “rural” is being defined, Powell said. U. of Va. Medical Dir. Karen Rheuban agreed, saying that “collaboration across the [regulatory] agencies [was] needed to [come up with] a single definition of ‘rural.'”

One of the “key” changes in the upcoming order is the “expansion of the rural health program to include discounts on Internet access for rural health care providers,” Powell said: “I believe that action will better enable rural health care providers to offer [advanced telemedicine] services.” He said the order also would clarify that dedicated emergency departments in for-profit rural hospitals were “public” health care providers eligible for support: “We conclude that emergency departments are public in nature because they are required by other federal laws to examine and stabilize all patients who walk in the door.” The decision will allow, for example, an additional 4 emergency departments in for- profit rural hospitals in the U. Va. telemedicine network to participate in the rural health care program, Powell said.

An FCC official said the order would broaden the scope of entities eligible to participate in the program. For example, the official said, the Commission wanted to liberalize the rules to allow rural health care clinics that operated as such on a part-time basis to receive partial support. The current rules require that rural health care clinics operate as such on a full-time basis to be eligible for the support. The new rules, unlike the current ones, also would allow rural health care clinics that shared a building with other entities to apply for the support, the official said: “A general principle the Commission is looking at is if there is an entity that has both eligible and noneligible portions, then the eligible” one can receive support. The order also would address the way rural and urban rates for telecom services were compared. Under current rules, the Commission said, such comparison may result in relatively small support amounts for many health care providers.

Raising awareness about the program is crucial to increase participation in the rural health care mechanism, FCC Consumer & Governmental Affairs Bureau (CGB) Chief Dane Snowden said. “One of the things we do is getting out to rural America [to see] what the challenges are, what the barriers are and what we can do to fix the problems… We want to make sure that Americans are aware of the services available for them.” Powell said as part of the outreach campaign announced by the CGB earlier this year, “the Commission will reach out to the Appalachian region, and coordinate our outreach efforts with the Appalachian Regional Commission’s [ARC’s] ongoing efforts.” ARC Federal Co-Chmn. Ann Pope said the group planned to conduct a series of workshops in coordination with the FCC to educate rural health care providers about resources available, including funding through the universal service rural health care program. Snowden said the Commission also had started the Indian Telecom Initiative Program about a year ago, and “our goal there is to” address the challenges, which he said were “unique by region. One size doesn’t fit all.”

To ensure benefits of the program are distributed fairly, the Commission in its new rules would “make sure that rules will not inadvertently prevent [some] parties from receiving support because of demographics” or other reasons, the official said. For example, the official said, current rules “limit the distance-based charges, which is the distance of the health care provider to the nearest city of 50,000 or more within the state, and the Commission is looking to extend that distance.” So far, the program has provided support to rural health care providers in 45 states and the U.S. Virgin Islands. Among the states that have received the most support over the last 5 years are Alaska ($17.9 million), Neb. ($1.2 million), Minn. ($1.1 million), Mont. ($1.1 million) and Ariz. ($1.1 million).

Improved telemedicine has become a matter of national security, the FCC said. “Additional support may improve the ability of rural communities to respond in the event of a chemical or biological attack or outbreak of disease, and thereby increase national security,” it said: “In the aftermath of recent national events, the importance of such a network to national security and public safety is significant.” Said Powell: “One of the things we recognized after September 11 was that you can easily begin to imagine critical national emergencies in which a very specialized type of expertise is needed.”

FCC Comr. Abernathy said the program’s benefits extended beyond the U.S. borders: “Developing countries learn so much from our telemedicine… because [some of them] don’t look like Washington or New York,” but rather “like our rural areas.” Rheuban said the program also benefited U.S. health care providers by allowing them to save money on telecom services. For example, she said telemedicine had allowed the U. of Va. to reduce its telecom expenses to $320 per month for T1 connection to Wise, Va., from $1,000 per month in 1996, when the Telecom Act was passed. Before the passage of the act, she said the U. of Va. had to pay $5,800 per month.