FCC Rural Broadband Funding Is a Step Forward, But Not Enough

Pandemic-boosted telehealth will persist and provide a reliable revenue stream to rural health systems, yet infrastructure investment is needed to boost Internet access.

The last few weeks have brought good news and bad news for the health of rural America. On a positive note, the Federal Communications Commission (FCC) awarded $9.2 billion to expand broadband access to more than 10 million rural Americans to close the digital divide. At the same time, rural Americans may be among the last to receive the COVID-19 vaccine due to logistical challenges, underfunded and overburdened hospitals, and skepticism among rural populations.

Azalea Health is a cloud-based electronic health records provider serving over 800 clinics and critical access hospitals across rural America. CEO Baha Zeidan recently answered some questions from HealthLeaders about what needs to happen next to move rural broadband closer to the top of the priority list to improve rural health in America as the pandemic continues.

HealthLeaders: Since the shortfall of infrastructure certainly is some multiple of $9.2 billion, how much difference can this current FCC initiative make?

Zeidan: The recent FCC initiative will deliver high-speed broadband to 5.2 million. However, this still leaves around 35 million without coverage. So while it’s an important step forward, it’s clearly not enough to ensure everybody has equal access to the Internet.

HL: How will this FCC funding impact healthcare delivery in rural America?

Zeidan: A connected community is a healthier community. Internet access allows people to educate themselves on their health and connect with doctors when they need to. Of course, online health misinformation is still a challenge, but at least people can contact their doctors for clarity, or research the side effects of their medications. Broadband can also help rural health providers with recruiting, many of whom suffer from staffing shortages. Finally, it’s worth noting that telehealth will likely remain a staple of care following the pandemic. Telehealth allows healthcare providers to reach patients that would otherwise have to drive long distances to reach a clinic, saving time and energy and lowering a critical barrier to care. It also gives providers a reliable revenue stream as they recover from the financial fallout of suspending elective procedures during the pandemic. This FCC funding will help make telehealth access equitable.

Baha Zeidan, CEO, Azalea Health (Photo courtesy of Azalea Health)

HL: What do you think of the FCC’s plans to expand rural broadband in general?

Zeidan: I applaud the FCC for taking steps to expand rural broadband access, which couldn’t come at a more critical time. Telehealth has been a lifeline through the pandemic, but far too many lack the connectivity to take advantage of this technology. Moving forward, telehealth will be a vital source of healthcare for patients who would otherwise have to travel for a half hour of more to visit a hospital or clinic, enabling these patients to be more engaged in their health. It will also be a way for rural hospitals, many of whom were already struggling financially before the pandemic, to reach new patients and boost their revenues to stay open and continue serving their often vulnerable communities.

HL: Given the renewed push to satellite-based broadband, such as SpaceX’s Starlink, does the current mix of wired and wireless broadband make sense? Can systems such as Starlink provide meaningful, affordable Internet access to rural communities?

Zeidan: The FCC certainly thinks satellite systems like Starlink can work—they gave SpaceX almost $900 million. But it’s not a sure bet. Space-based Internet has been attempted and failed in the past, so there’s no guarantee it will work this time. Assuming they can successfully deploy the thousands of satellites needed to provide reliable Internet, you would still need to install expensive devices across rural America to receive and transmit the data to the satellites. That said, I think it’s important that we encourage innovations for people that have been left behind. Satellites can be part of the solution, but I don’t think we should give up on tried-and-true broadband technologies that haven’t made it to rural American due to lack of investment.

HL: To what degree does this FCC funding provide solutions for both healthcare services and patients? What is the mix of this funding, relative to both stakeholders?

Zeidan: The FCC’s funding announcement doesn’t specify the locations that will receive broadband coverage through the funding. But regardless of where the broadband is expanded to, both patients and healthcare providers stand to benefit as more people will be able to stay connected with their doctors via telehealth.

HL: Urban ISPs (Internet Service Providers) are doing VERY well. (For example, Comcast had net income of more than $13 billion in 2019.) To what degree is the failure of rural broadband's promise an inability of regulators to compel mega-profitable urban ISPs to invest in rural markets?

Zeidan: The government absolutely needs to step in and subsidize ISPs to serve rural areas. And there’s precedent for this too. In the past, the government subsidized energy companies to install power lines in rural areas. The problem is that rural telecommunications infrastructure is inherently unprofitable. There is simply too much space to cover and not enough users to pay for the miles and miles of wires that need to be laid. However, it’s in the government’s own interest to invest in rural broadband. In the digital age, economies depend on broadband access. With remote work now viable following the pandemic, broadband access could attract people from busy urban areas to the quiet solitude of rural areas. And, as more rural businesses are enabled to thrive, governments will see increased tax revenue as a result.

HL: How should health IT address the challenges of vaccine distribution in rural America?

Zeidan: Rural America cannot afford to be an afterthought for vaccination. These communities have high rates of comorbidities that increase their risk of life-threatening illness from Covid-19, and their hospitals are being overwhelmed by Covid-19 patients. The health system is fragile, and the longer hospitals need to delay elective procedures and routine care to save capacity, the more hospitals will be forced to close. While it’s true that rural areas pose unique challenges for vaccination, health IT can be part of the solution. Data sharing on health information exchanges can help state-level public health officials track who has been vaccinated, who should be prioritized for vaccination, and which hospitals serve higher numbers of vulnerable patients. Telehealth and mobile health apps can support outreach to at-risk patients and dispel misinformation about vaccines. And cloud-based access to electronic health records can support the deployment of mobile, pop-up vaccination clinics.”