Healthcare, Telecom Stakeholders Ask FCC to Revise or Delay Draft Rural Telehealth Order

"They've plopped this report and order on the table with a lot of new ideas that haven't been thought through," John Windhausen, executive director of the Schools, Health and Libraries Broadband Coalition, told us. Finalizing the order as is could lead to funding delays and uncertainties, he said. SHLB is particularly concerned with new wording that gives the Universal Service Administrative Co. authority to set telehealth subsidy rates for services in different types of rural areas. Windhausen said USAC shouldn't have authority over rate setting, but if it does, it must add to its staff and give stakeholders an opportunity to review the formulas it uses: "It must be clear and transparent."

"Setting the rates is effectively setting the policy" for the USF program, Windhausen said. If rates are set too low to compensate telecom providers for the cost of servicing rural hospitals and clinics, they'll drop out of the program, he said, which could influence teleheath's overall success or failure in the country. In a July 22 letter to FCC commissioners, SHLB asks the agency to "re-draft the proposed Order as a Further Notice of Proposed Rulemaking and request expedited comments" on recent proposals. Short of an FNPRM, Windhausen suggested commissioners postpone addressing the draft order until a September or October open meeting to give them time to integrate new proposals into the order.

SHLB also wants the FCC to increase the funding cap for the rural telehealth program. "These rural health care providers need more and more bandwidth capacity each year," perhaps 20 to 30 percent more each year, Windhausen said, "but it doesn't look like this FCC order reflects this."

Alaska stakeholders have their own concerns. The draft "could result in substantial loss of service," Karen Brinkmann, outside counsel to Alaska Communications, told us. The company isn't asking the FCC to delay its vote, she said, but it wants changes as outlined in a July 19 letter.

Alaska has the largest land mass of any state but is the least densely populated, Brinkmann noted, and it faces difficult terrain and harsh winters that make it hard to deploy fiber. Several hundred communities in the state lack fiber facilities, roads and electricity but have people who need healthcare. Reaching them is difficult and expensive, but their need for telehealth services is so great because it can be difficult to recruit doctors to work in such remote places, she said. Healthcare facilities may have locally generated power but be off the national electric grid, she said.

Delivering telecommunications connections to such remote areas can be challenging for multiple reasons, Brinkmann noted. To get needed equipment to some remote sites, "you have to fly in everything," including technicians. Under the FCC's draft, a new median rate for various types of rural areas would limit the top spending allowed for different telecom services connected to telehealth. Alaska Communications recommends subdividing the "extremely rural" categories solely for that state. No other state has the same combinations of extremes, Brinkmann said: "Even in Hawaii, you don't have the vast rural areas hundreds of miles from the nearest fiber ring."

The types of telehealth applications that healthcare providers access today require connections with higher bandwidth than ever, Brinkmann said. For example, she said, a doctor may want to remotely discuss an X-ray or an MRI image in real time with a patient while they can both look at it.

In a July 17 letter to FCC, GCI Communications said "the core provisions regarding the determination of comparable rural and urban rates are difficult to evaluate," especially given the short time between the release of the draft order on July 11 and the sunshine period that starts Thursday. "An erroneous determination of the rural rate for a similar service in a comparable rural area will likely mean that services necessary to support telemedicine do not get built or upgraded in high cost rural areas, particularly when there are no other entities in that rural community buying services similar to the rural healthcare provider," said GCI. It said USAC must take great care not to group lower quality services with high quality services, such as medical procedures that aren't latency tolerant, when evaluating the technical specifications that a healthcare provider requires. Many healthcare providers will need dedicated symmetrical connections to deliver telehealth services rather than so-called "best efforts" grade connectivity.

GCI also recommends against using USAC's existing E-rate database to inform subsidy rates for the rural telehealth program: "Bad data will lead to inappropriate rates."

Alaska-based Bristol Bay Area Health asked the FCC in a July 22 letter to remove the order from the Aug. 1 agenda "so we can better assess information included in the proposed Report and Order and that issues raised in the draft document can be clarified."