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America’s Race for Universal Telehealth May Rely on Making Medicare Payments Permanent



Photo of Kimberly Sanders by Stephanie Daniel courtesy KUNC

August 31, 2020 – Kimberly Sanders was recovering from a heroin addiction when the coronavirus struck.

She had been homeless before and struggled to commute long distances for treatments. But because of her failure to attend several appointments, her previous doctors stopped seeing her.

Years later, in a bid to get clean, she moved to Estes Park, Colorado, and began attending a treatment program at Salud Family Health Center.

“It’s beautiful. It gets me away from the hustle and bustle of everything,” Sanders told KUNC, a radio station in Greeley, Colorado. “Estes Park is like a little bubble – a little protective bubble, and I like it.”

Then, because of the coronavirus, Salud began limiting in-person treatments.

“I didn’t know what we were going to do. I had no clue,” she said.

Sanders’ story is illustrative of the experiences of millions of Americans. And while America is racing to provide increasingly vital telehealth services universally during the coronavirus, there are still significant challenges with conducting telemedicine.

Fixes for permitting telemedicine during the coronavirus

In early March, Congress passed legislation that would temporarily allow patients in need to access telehealth services across state lines, as well as other key expansions.

The law, including as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6074, allows psychologists to treat patients from their homes, permits telehealth for Medicare recipients across the country and not just in underserved rural areas, and also allows nursing home patients to receive services via telehealth.

In August, President Donald Trump signed an executive order would allow individuals to pay for telehealth with Medicare in certain circumstances. It also directs task forces from the Departments of Agriculture and Health and Human Services to be created, and it calls for one of the FCC’s existing task forces to focus on telehealth.

The executive order was widely praised. At the Republican National Convention, Registered Nurse Amy Ford went so far as to say that Trump’s Executive Order would save lives.

“As a healthcare professional, I can tell you without hesitation, Donald Trump’s quick action and leadership saved thousands of lives during COVID-19,” she said. “And the benefits of that response extend far beyond coronavirus.”

The American Telehealth Association also praised the move, saying that it was a necessary step “to ensure individuals receive the care they need during this national health emergency.”

However, some worry that these expansions could leave millions unconnected when the virus is over.

“There is more work that needs to be done, on both the federal and state levels, to cement these gains and make permanent the waivers put in place in response to COVID-19,” said ATA CEO Ann Mond Johnson.

She said that while Trump’s Executive Order was a step in the right direction, continued work is needed to combat the coronavirus’s potential to harm vulnerable populations.

“The stresses on our healthcare system were well-documented prior to the pandemic – including crippling provider shortages, escalating costs, and an aging population – and will only be exacerbated as our nation begins to recover from this health crisis,” she said.

But Frank Micciche, vice president of public policy and external relations at the National Committee for Quality Assurance, thinks that telehealth legislation will continue to advance out of necessity.

“I think the Administration and even the private sector would have a really hard time going back to pre-COVID, Just because people on all ends of the system, providers, patients, you name it, have appreciated a lot of the benefits,” he said.

The future of telehealth after the pandemic ends

Companies like Teladoc, which partners with medical practitioners across a variety of disciplines, have become essential arbiters for providers historically unable to offer services across state lines.

A representative for Orlando Health Network said that they have advanced their remote services substantially during the coronavirus thanks to Teladoc.

“We deployed a dedicated COVID-19 screening and questions service on our Virtual Visit platform,” they said. “This was available to the community, as well as offered in partnership with several Central Florida employers to give patients 24/7 access to an Orlando Health physician for their questions about COVID-19.  We have done over 60,000 virtual visits during COVID-19.”

The representative said Orlando Health is positive about the future of telehealth.

“We believe that consumer demand will drive the legislative environment and we are optimistic that coverage for telehealth services is here to stay,” they said.

However, while federal funding and legislative proposals are plenty, the future of telehealth is uncertain. It is unclear which, if any, broadband and telehealth stimulus bills will pass, and a unified national telehealth expansion effort down to the local level is unlikely.

Sanders said that the ease of access that remote health has afforded her will make it difficult to return to in-person appointments if inter-state telehealth provisions are not agreed upon.

“I just step to the back at work for about 15-20 minutes and then I’m back right at work,” she said. “I don’t want to have to go back to having to go in person.”


Digital Literacy Training Needed for Optimal Telehealth Outcomes, Healthcare Reps Say

Digital literacy should be a priority to unlock telehealth’s potential, a telehealth event heard.



Photo of telehealth consultation from Healthcare IT News

WASHINGTON, May 18, 2022 – Digital literacy training should be a priority for providers and consumers to improve telehealth outcomes, experts said at a conference Tuesday.

Digital literacy training will unlock telehealth’s potential to improve health outcomes, according to the event’s experts, including improving treatment for chronic diseases, improving patient-doctor relationships, and providing easier medical access for those without access to transportation.

Julia Skapik of the National Association of Community Health Centers said at the National Telehealth Conference on Tuesday that both patients and clinicians need to be trained on how to use tools that allow both parties to communicate remotely.

Skapik said her association has plans to implement training for providers to utilize tech opportunities, such as patient portals to best engage patients.

Ann Mond Johnson from the American Telemedicine Association agreed that telehealth will improve health outcomes by giving proper training to utilize the technology to offer the services.

The Federal Communications Commission announced its telehealth program in April 2021, which set aside $200 million for health institutions to provide remote care for patients.

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Expert Opinion

Craig Settles and Sean Gonsalves: Telehealth For All is a ‘Stroke of Genius’

Without access to a secure broadband connection, the co-author of this Expert Opinion would have died.



Craig Settles (left) and Sean Gonsalves are the authors of this Expert Opinion.

My colleague Craig Settles likes to say he had a “stroke of genius” when writing his last book about building the gigabit city. “I literally had an ischemic stroke at 10:30 p.m. on a Saturday night,” he recalls. “If I had been in a low-income urban community with poor communication infrastructure, or in a rural area with bad broadband, I’d probably be dead.”

The “genius” part was realizing broadband is magic that directly or indirectly enables us to perform minor and major miracles that we could not do before, but faster and easier.

When Craig moved to Alameda, California, situated less than five miles from the heart of Silicon Valley, he could not get cell service without a signal booster, and even then it was sketchy. Several years later the service was better, which allowed him to speed-dial his best friend who called 9-1-1.

The neurologist who set up the stroke center in Alameda Hospital had mirrored much of its technology and servers in her home so she could see everything the ER staff was seeing as they administered life-saving procedures within 25 minutes of Craig’s gurney hitting the ER door.

While Craig counts his blessings, over 14 million urban households do not have broadband in their home – 75 percent of whom are African American and other people of color. Millions more technically have home Internet service but don’t have the connection speeds and capacity to use the applications needed for remote work and school, or telehealth.

And don’t forget the 4 million rural homes that do not have broadband subscriptions.

Broadband as Social Determinant of Health

The essential nature of broadband came to the fore with the onset of the pandemic. And it compelled states and local communities across the nation to take the connectivity crisis far more seriously, especially with the influx of federal funds from the American Rescue Plan Act and the Infrastructure Investment and Jobs Act.

Although advocates commonly, and understandably, tout the importance of broadband access in the context of remote work and schooling, what often gets overlooked are the transformative powers of telehealth and its potential to drive broadband adoption.

It’s no exaggeration to say that broadband is a major social determinant of individual health as it enables access to virtual healthcare and facilitates a host of other things critical to health, such as education, employment, housing, and social services, all of which require broadband, most especially for telehealth applications.

More than video chats with your doctor, telehealth uses high-speed Internet connectivity to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care. Public health, in particular, can leverage telehealth to a great advantage.

Yes, healthcare providers are increasingly integrating telehealth into the delivery of care. But, if the patients most in need of better access to healthcare do not have access to broadband, as well as computing devices and digital skills, tremendous healthcare benefits and cost-savings will be needlessly missed.

This suggests that “fiscally conservative” elected officials, many of whom claim to support universal access to broadband while lamenting the high cost of healthcare, have been thinking about this whole thing backwards. Instead of wailing about the cost of building universal robust broadband infrastructure that could be used for telehealth, why not flip the script?

Achieving universal broadband infrastructure that would last a lifetime would cost on the order of $100 billion, which is just two and a half percent of what we spend on healthcare in this country every single year. Hundreds of academic and industry studies say that even the most conservative telehealth initiatives save more than two and a half percent of system costs.

Talk about a return-on-investment! A hint of this can be seen in a study done by the National Center for Biotechnology Information which found there were as many as 3.5 million potential preventable adult inpatient hospital stays in 2017 alone. That amounted to $33.7 billion in health care costs just for that year.

Telehealth can eliminate many of those stays. And in terms of improving health outcomes, the study further found that the elderly, men, Black communities, and those insured with Medicaid would reap the biggest benefits.

So why not exploit the math, and pay for broadband using healthcare savings? Let’s connect every home, hospital, and community anchor institution in the country to robust broadband, and transform healthcare while bringing it into the 21st century. The municipal broadband model in which local communities build and own the infrastructure is ideal.

Telehealth Can Drive Broadband Adoption

Looking at it this way, universal access to telehealth has the potential to simultaneously solve the connectivity crisis and ensure that millions of families can lead healthier lives.

Here are six tactical ways of using telehealth to maximize public health in a community along with increasing broadband adoption.

  1. Re-inventing the doctor’s office visit for a variety of healthcare practices

Understanding telehealth, all you need are four walls, an Internet connection, a computer, a healthcare partner, and a healthy imagination to create a range of practical telehealth solutions.

Transform barbershops and hair salons into Covid vaccination and hypertension screening centers. The school nurse’s office can now become school telehealth centers. Libraries are starting to add telehealth kiosks.

Libraries Without Borders uses interactive Web health content, laptops, and wireless gear to outfit intercity laundromats on Saturdays. Tucson used ARPA funds to build out a wireless network on top of the city’s fiber infrastructure and gave 5,000 low-income homes the ability to have telehealth resources.

  1.  Telehealth can marry chronic healthcare, home care, and public health

Frederick Memorial now distributes hundreds of tablet computers for remote patient monitoring  in patients homes to check their vital signs, changing medical conditions and treatments, with data that goes to the hospital daily.

Urban hospitals should partner with ISPs to leverage the FCC’s Affordable Connectivity Program subsidy of up to $30 per month for Internet service and up to $75/month for households on Tribal lands. ACP also offers a $100 discount on computing devices.

  1. Enhance the emergency response and Emergency Department to save more lives and money.

African Americans and other populations of color have the highest rates of strokes, heart attacks, and other medical trauma. We could reverse the trend of hospitals that abandon poor urban communities and replace them with city telestroke or telehealth critical care “broadband subnetworks” that are hosted by major hospitals and linked to Federally Qualified Health Center, clinics, and other facilities.

  1. Expand efficiency of mental healthcare delivery

Mental health professionals getting to see patients in their homes and therefore providing an alternative to needing to go to a therapist’s office can not only eliminate no-show appointments but can provide those most in need of therapy with broader access to a variety of specialists.

Leveraging telehealth can be especially empowering for underserved communities in which approximately 30% of African American adults with mental illness receive treatment each year, compared to the U.S. average of 43%, according to the National Alliance on Mental Illness.

But as Carly McCord, Director of Clinical Services at the Texas A&M Telehealth Counseling Clinic, rightly points out: “Often we’re talking about intensive therapy, like treating PTSD, which you can’t do with crappy Internet connections. When your patient’s disclosing a trauma and your connection glitches, or you miss a word and have to say, ‘I’m sorry. Can you repeat that? ‘This is a huge problem.”

  1. Improving senior care and facilitating aging in place for our nearly 60 million seniors

Three-in-four older Americans want to stay in their homes and age in place, according to a AARP survey. And, if offered a choice, about 53 percent of respondents say they would prefer to have their health care needs managed by a mix of medical staff and healthcare technology.

A key broadband element in this telehealth equation is “smart home” technologies that include wirelessly-controlled sensors. Some sensors now can determine whether a person sat up in bed or actually fell on the floor, if patients are eating regularly, or if they are taking their medications on time.

  1. Re-imagining what hospital care can be

In areas prone to natural disasters, make prior arrangements with hotels, college dorms, warehouses, and other facilities where you can bring in generators, computers, telehealth equipment, and wireless intranets.

Use these buildings for seniors with health conditions who have been displaced: people with chronic illnesses and patients with non-serious injuries from the disaster should those people not have easy access to other residential or healthcare facilities.

Building and subsidizing access to robust community-owned broadband networks is a wise investment because it will improve health outcomes and return significant community savings for decades to come.

And with a flood of federal funds available to build broadband infrastructure and advance digital equity, we have a once-in-a-life opportunity to stitch this all together and deliver telehealth for all.

Sean Gonsalves is a Senior Reporter, Editor and Communication Team Lead for the Institute for Local Self Reliance’s Community Broadband Networks Initiative. Saved from a stroke by telehealth, Craig Settles pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth-broadband integration initiatives. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC.

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‘Ample Evidence’ Telehealth Contributed to National Covid Response: FCC Commissioner Starks

Geoffrey Starks said adoption of telehealth services has ballooned during the pandemic.



Photo of FCC Commissioner Geoffrey Starks

WASHINGTON, March 8, 2022 — Federal Communications Commissioner Geoffrey Starks said the agency’s Covid-19 Telehealth Program is helping American communities battle the pandemic.

“Even early in the pandemic, experts agreed that receiving care remotely could both meet many patients’ needs and help prevent community spread of the coronavirus,” Starks said at the FCC’s Connected Health Symposium Thursday. “Now, two years into this pandemic, the Commissioner said “we have ample evidence to show that telehealth made a difference in the national response to COVID-19.”

The FCC’s Telehealth Program was announced in April 2021 and has set aside $200 million for health institutions to continue to provide remote care for patients. The Connected Health Task Force is a working group within the FCC charged with gathering public and private stakeholders to accelerate the adoption of the latest health care technologies.

Americans have embraced telehealth since the onset of the pandemic. Researchers at the Urban Institute found that during the first six months of the pandemic, one-third of Americans have had a telehealth visit for health care.

Lower-income Americans have also sharply increased their use of telehealth services. According to the Center for Medicare and Medicaid Services, telehealth visits for Medicaid and children’s’ health insurance programs enrollment increased by more than 2,600 percent since 2019.

Starks also noted that as community behaviors change while communities lift restrictions, the McKinsey foundation found that telehealth levels have stabilized — to thirty times higher than before the pandemic.

Starks said communities have the opportunity to “leverage once-in-a-generation broadband legislation to expand access to high-quality health care” by enabling greater access to telehealth.

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