It's been six years since the federal government provided $418 million in grant money to the Rural Health Care Pilot Program as part of an effort to bring broadband to rural providers.
This week the Federal Communications Commission issued an upbeat and somewhat obvious 98-page report that highlights the progress made by the pilot project since its inception in 2006, offers obvious commentary on the benefits of telemedicine, and details the lessons learned.
A brief history: The pilot program was created as part of the FCC's statutory mandate to implement universal communications services to rural providers. The idea was to improve access to quality care and reduce costs for rural providers by giving them remote access to the broader array of services and resources available to many urban providers.
The FCC awarded the $418 million to 69 rural projects, giving the providers one-time funding to cover 85% of the cost of construction and deployment of broadband networks to providers in urban areas. The pilot now supports 50 projects in 38 states, Guam, American Samoa, and the Northern Mariana Islands. The information gleaned from the pilot project will be used to shape the permanent RHC program.
Not surprisingly, the report found that broadband healthcare networks and telemedicine "improve the quality and reduce the cost of delivering healthcare in rural areas…. In addition to delivering needed medical care to patients in remote locations, telemedicine lowers the cost of providing healthcare, reduces travel time and expense for patients, providers and doctors, and brings needed revenue to endangered rural clinics and hospitals. Broadband networks also facilitate other important telehealth applications—such as the transmission of medical images, exchange of electronic health records, remote consultations with specialists, and training of rural medical personnel."
This is not news. All of this makes perfect sense and for the most part the FCC is stating the obvious. There are large parts of this report that can be skimmed over. Most readers will find that the more interesting findings were about what works.
For example, the report found that consortium applications are more efficient because they allow several providers to share the administrative, network design and other costs.
Consortiums foster coordination of care networks and give smaller providers access to access to experts and resources of larger providers. In addition, the consortiums used bulk buying and competitive bidding to provide leverage for large numbers of geographically disperse provider sites that can usually result in higher bandwidth, lower prices and better service.
While the stated purpose of the project is to improve quality and reduce costs in rural areas, the pilot found that the urban partners are a critical piece of the puzzle. "Broadband networks often bring to patients in rural areas the additional medical expertise, creativity, technical know-how, and innovation available in large urban medical centers. The leadership, technical and medical expertise, and administrative resources provided by urban health care providers also have proved central to the success of many Pilot projects."
What other gems were uncovered in the FCC report? Well, commission also determined that most providers don't have the technical expertise to manage broadband networks and that, as a result, they don't want to own the networks. "The majority of Pilot projects have created successful broadband networks by purchasing broadband services from a third party, rather than constructing and owning their own broadband facilities.
Mechanisms such as long-term leases, prepaid leases, and indefeasible rights of use of facilities for specified period of time help many projects obtain the bandwidth and service quality they needed," the report said.
And finally, even with billions in federal seed money, the report acknowledged that funding challenges for broadband remain a key issue for rural providers that operate on thin margins or in the red.
As for accomplishments to date, the study noted that:
- 2,107 providers were "on target" to receive $217 million in universal service support by January 2012, with the average award of about $100,000 per provider.
- Project sizes range from fewer than 10 to more than 150 provider sites; about one-third of the projects each have more than 50 provider sites receiving support through the pilot.
- The five largest projects are statewide networks in California, Colorado, Oregon, South Carolina, and West Virginia. So far, these networks are on target to receive funding to connect more than 800 providers.
- Forty-four of 50 projects that receive pilot funding include urban providers. Approximately 35% of all providers that received funding commitments in the pilot as of January 2012 were classified as urban, or 733 of the 2,107 total.
- Pilot leaders often come from large medical institutions and universities in urban areas, which often serve as hubs for the network receive support for the equipment that enables the entire network to operate.
- Pilot project participants purchase higher bandwidth connections than do participants in the FCC's existing program, which defrays the cost of telecommunications and Internet access services for rural providers. Most Pilot Project participants purchase 10 Mbps or faster connections, which are much faster than the connections that typically are purchased in the permanent RHC Program, the vast majority of which are 3 Mbps or less.
- Most pilot projects purchase broadband services from commercial providers rather than build and own their own networks.
As we've already noted, this is a status report and most of the findings are self-evident. Don't expect much breaking news as you skim through these 98 pages.
However, it's interesting to read the report as a measure of how far we have come over the past six years toward the acceptance and promotion of telemedicine. In 2006, the FCC was raising questions about the value of access to broadband and telemedicine as critical components for improving quality, maximizing limited resources, and reducing costs. In 2012, those questions have been answered. The value is inarguable.
John Commins is the news editor for HealthLeaders.