update on the fcc ’ s rural health care program
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Update on the FCC’s Rural Health Care Program
Federal Communications CommissionState and Local Government Webinar
September 27, 2012
Chin YooAttorney Advisor, Wireline Competition Bureau,
Telecommunications Access Policy Division
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Health Care in the News
• How to improve quality of care?• How to save on costs?
IOM Report: “Best Care at Lower Cost”
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Health Care & Broadband, Part I(Electronic Health Records)
• HITECH Act: Incentives for physicians and hospitals to achieve “meaningful use” of electronic health records
• IOM: 20% patients reported that test results or medical records not transferred in time for appointment
• “Phase 2” Meaningful Use: ability to exchange these records with others
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Health Care & Broadband, Part II(Telemedicine)
• Iowa: The Iowa Health System transmits high resolution images via tele-radiology, which has improved diagnoses and has enabled more patients to stay at local hospitals.
• South Carolina: Palmetto State Providers Network uses tele-OB/GYN services to treat high-risk expectant mothers, saving both doctors and patients travel time and reducing the patient no-show rate.
• South Dakota: Heartland Unified Broadband Network (HUBNet) members use E-emergency, E-ICU, and E-Pharmacy programs to bring specialist care to remote areas.
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Overview of FCC RHC Discounts
Services Supported Discount Rate
Telecommunications Services Urban-rural differential
Internet Access Services 25 percent*
Deployment of statewide or regional health care broadband networks for rural and urban providers (infrastructure, services, equipment)
85 percent
“Primary” Program: Telecom Services
“Primary” Program: Internet Access
PilotProgram
* 50 percent for entirely rural states and territories (American Samoa, U.S. Virgin Islands, Northern Mariana Islands, and Guam qualify)
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Eligible Health Care Providers“Public” or “Nonprofit” (includes government health care providers)
Rural only• Includes circuits to urban if one side is rural• Eligibility lookup tool:
http://www.universalservice.org/rhc/tools/Rural/2005/search.asp• Reform rulemaking – open issue on urban eligibility
7 Eligible Provider Types• Local health departments or
agencies• Community or migrant health
centers • Community mental health
centers• Rural health clinics
• Not-for-profit hospitals• Post-secondary educational
institutions offering health care instruction, teaching hospitals, and medical schools
• Consortia of one or more of the above
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Applying to the Primary Program
The Universal Service Administrative Company (USAC) administers the program under direction from the FCC.• http://www.universalservice.org/rhc/Getting Started:• http://www.universalservice.org/rhc/about/getting-started/default.aspxWelcome Packet:•http://www.universalservice.org/_res/documents/rhc/pdf/handouts/RHC-Welcome-Packet.pdf
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Pilot Program Fostered Creation of Health Care Networks
http://www.fcc.gov/maps/rural-health-care-pilot-program
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Pilot Program: Summary of Key Benefits and Lessons Learned
Pilot-funded networks improve the quality and reduce the cost of health care in rural areas.
Consortium applications lower broadband costs through bulk buying and create administrative efficiencies.
Most health care providers (HCPs) prefer to use third-party networks rather than construct their own.
Urban HCPs in networks provide medical and technical expertise, leadership, and administrative support to rural sites.
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Trends Pilot Program Examples
Reduced time to treatment
Lives saved
Bacon County Hospital (GA): Connection to specialists allowed rapid administration of drug to save stroke patient’s life
TelemedicineSavings to taxpayers
Palmetto State (SC): Tele-psychiatry saved Medicaid program $18 million
Remote consults
Reduced transport costs
Barton Health (CA): Patients save almost $30,000/month in travel costs due to remote consults
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Health Care & Broadband, Part II(Telemedicine)
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Pilot Program Findings: Bulk Buying Enables Lower Rates, Higher Bandwidth, and
Better Service Quality
Pilot Program
Primary Program
Individual Competitive
Bidding
Bulk buying power
• Only 16 percent of funding requests receive bids at all
• 94 percent of projects had more than one vendor bid
• Over 120 vendors have been selected to provide services in Pilot Program
Consortium-led Competitive
Bidding
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0
500
1000
1500
2000
2500
3000
3500
4000
0
100
200
300
400
500
600
700
1.5 to <3 3 to <6 6 to <10 10 to <25 25 to <100 100+
Bandwidth (Mbps)
# of
HCP
s#
of C
ircui
ts
Primary Program
PilotProgram 0
1000
2000
3000
4000
5000
6000
1.5 to <3 3 to <6 6 to <10 10 to <25 25 to <100 100+
Cost
($)
Bandwidth (Mbps)
Primary
Pilot
Bandwidth Usage in Primary and Pilot Programs
Avg Total Monthly Recurring Costs – Primary and Pilot Program
Participants
Pilot Program Findings: Participation by Urban Providers Yields Benefits
Health Care Administrative Technical• Access to
specialists• Cost savings from
telemedicine• Training of health
care personnel in rural areas
• Leadership of consortia
• Sources of technical expertise
• Financial resources
• Efficiency of network design
• Urban hubs, rural spokes
DRAFT FOR REVIEW
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Reform of Rural Health Care Program
• The FCC issued a Notice of Proposed Rulemaking in 2010 proposing to reform its Rural Health Care Program.
• In the Notice, the FCC proposed two separate programs: a Health Infrastructure Program and a Broadband Services Program.
• The FCC recognized the value of gaining experience from the Pilot Program in shaping a reformed permanent Rural Health Care Program.
• The FCC expects to adopt its reformed program by the end of 2012.
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For Further Information:
At the FCC (Policy Questions)
Chin YooAttorney-AdvisorTelecommunications Access Policy DivisionWireline Competition Bureau
(202) 418-0295Chin.Yoo@fcc.gov
www.fcc.gov
At USAC (Application Questions)
Paloma CostaProgram Manager of OutreachRural Health Care
(202) 772-6374pcosta@usac.org
www.usac.org/rhc
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