FCC Chairman Ajit Pai is the child of two doctors. So for him, the FCC's role in providing healthcare services, via telehealth, to rural communities is personal.
"When I was a kid in the late 1970s and 1980s, my dad, who was a urologist in the small town of Parsons, Kansas would often hit the road," Pai said today in an address to the Connected Health Conference in Boston. "He would drive 45 minutes or an hour across southeast Kansas to make sure that patients in even smaller surrounding communities could see a specialist. Even now I’m amazed at the amount of time he spent driving those back roads. But there are fewer like him around. And it’s becoming harder to recruit physicians to serve rural communities. It’s getting harder to keep rural hospitals afloat."
Pai spoke about a number of initiatives the FCC is funding or spearheading to help bring broadband and telemedicine services to those rural communities. Many of these initiatives come via the Universal Service Fund, the mechanism by which the FCC subsidizes telecommunications networks.
In healthcare specifically, the FCC recently raised the spending cap on the rural healthcare program, an initiative launched in 1997 to help healthcare providers afford the connectivity they need to operate — including connectivity for telemedicine and remote monitoring.
"Unfortunately in 2017, demand for this program outstripped the spending cap for the program," Pai said. "And that’s hardly a surprise when you consider that the program was established in 1997 over 20 years ago, during the days of dial-up — I’m sure you all remember those AOL CD-ROMs and the whirring of those modems — and the funding limit for this rural healthcare program had never been increased, not even for inflation."
This summer, the FCC raised that spending cap from $400 million to $571 million, a 43 percent increase, for funding year 2017.
"This reflects what the funding would be had the cap been adjusted for inflation all these years," he said. "We’re also adjusting for inflation going forward, allowing the program to scale as advances progress. We are also allowing any unused funds to roll forward to future years."
Pai said that the FCC expects to fully fund all requests under the program in 2018.
Care at home, cancer and opioid abuse
Pai announced several new initiatives specific to digital health during his presentation, including a new program the FCC is proposing to focus specifically on remote monitoring technology in patient homes.
"Our feeling is that patients would benefit from programs delivered directly in their homes, such as sensor-based remote monitoring, as well as in healthcare facilities," he said. "We’re looking at a proposed $100 million budget for this connected care pilot program and we’re seeking public input on how best to design it."
To improve cancer care in rural communities, the FCC has partnered with the National Cancer Institute to create a program called L.A.U.N.C.H. (Linking & Amplifying User-Centered Networks through Connected Health)
"This initiative, which we call L.A.U.N.C.H, has its roots in addressing the needs of rural, underserved communities," Pai said. "As a founding member of this initiative and through its Connect2Health taskforce, the FCC brings together government, academia and community health providers to bring high-quality cancer care closer to where patients work and live and to make access more reliable. As it develops these user-centered technologies, we hope L.A.U.N.C.H will be a scalable model for other communities in need."
Finally, Pai discussed ways the FCC can help with the opioid epidemic. These include an expansion of the commission's broadband mapping initiative and an innovation challenge aimed at generating new ideas for fighting the nationwide drug abuse crisis.
"Number one, to help address this epidemic, the FCC is expanding its mapping broadband health platform to include critical drug use data. This data is desperately needed by providers both to understand the problem and to gain insights about effective solutions. Our mapping platform is going to allow users to rapidly visualize, overlay, and analyze broadband and opioid data together at the national, state, and county level," Pai said. "Number two, our Connect2Health taskforce is going to launch a chronic pain management and opioid use challenge. We hope this challenge will stimulate innovative solutions."
Pai has become a controversial figure on the national stage for his role in ending the FCC's Obama-era net neutrality rules. While he has argued that the end of net neutrality would benefit telehealth services by allowing them to have priority over other uses of broadband networks, some legal experts and telehealth advocates believe the rules will actually harm rural practices.
"Ending net neutrality may address under-connected rural areas and stimulate new telecommunications infrastructure; however, competition among ISPs will be necessary to ensure that costs are kept in check," Kristi Kung wrote in a blog post for Sheperd Mullins early this year. "In areas with low to no competition in ISPs, typical in rural areas, providers and patients alike could be priced out of the connectivity required to support telehealth. An oversight and enforcement mechanism will be needed to ensure that connectivity for telehealth remains viable and affordable."
Hopefully, given Pai and the FCC's espoused commitment to telehealth access, the commission will pass additional rules to protect that access from inflated costs post-net neutrality.