Supporting Connectivity for Healthcare Providers: The FCC’s Healthcare Connect Fund

1. Supporting Connectivity for Healthcare Providers: The FCC’s Healthcare Connect Fund HIMSS Government Health IT Conference and Exhibition June 18, 2014 Matt Quinn Christianna Barnhart Federal Communications Commission

2. Federal Communications Commission Staff & Offices • Approx. 1700 Attorneys, Engineers, Economists, et al • HQ at 445 12th St, SW, Wash., DC • Lab in Columbia, MD • Field Offices: 3 Regional, 16 District, 8 Resident Agent Mission The FCC was established by the Communications Act of 1934 and is charged with regulating interstate and international communications by radio, television, wire, satellite and cable. The FCC's jurisdiction covers the 50 states, the District of Columbia, and U.S. possessions.

3. FCC Areas of Responsibility in Healthcare Rural Health Care Program: Supports broadband for health care providers, which promotes telemedicine adoption to expand patient access to specialists and drive down costs. Broadband: Advances both wireline and wireless communications services and technologies, thus enabling many medical and medical-associated applications. Spectrum: Provides access to the airwaves for wireless medical devices and various radio services that support Health IT applications, while preventing harmful interference. National Broadband Plan: Engages in a variety of actions and activities to facilitate Health IT under NBP recommendations.

4. The Promise of Broadband-Enabled Health Technology Expanding connectivity for health technology can: Increase access to health care and medical expertise, especially in hard to serve areas • Telemedicine and video conferencing allow rural health care providers to take advantage of specialists, training, and resources in urban centers Improve patient care by utilizing data to improve health care strategies • Patients who used a mobile tracking system for diabetes care received regular, tailored self-care messages and were able to achieve significant reduction in blood sugar levels over a year long study Reduce health care costs by using information to improve efficiency of care delivery • Telehealth can reduce the costs of medical care among the elderly by 25%, because it reduces the number of face to-face consultations needed • Costs related to data collection can be reduced by allowing patients and doctors to access health records remotely, increase efficiency, avoid duplication, and save between 20% and 30% in administrative costs

5. Lots Depends on the Availability of Broadband to Support Healthcare Needs New models of care The HITECH program Telemedicine Remote monitoring Sustainability of RECs and HIEs Generations of innovators Community development

6. We (Still) Invite Your Feedback and Proposals! Rural Healthcare Broadband Experiments: 224-231 • We seek comment on soliciting experiments that focus on ensuring that consumers have access to advanced services to address the increased and growing demand for telemedicine and remote monitoring. • We seek comment…on consumer-oriented rural broadband experiments that would improve patient access to healthcare. • http://transition.fcc.gov/Daily_Releases/Daily_Business/2014/db0131/FCC-14-5A1.pdf

7. We (Still) Invite Your Feedback and Proposals! Impact of Technology Transitions in Healthcare (Data Collection): 200 We seek comment on experiments that focus on the implications of the technology transitions on health care facilities and patients. We seek comment on data to help inform the Commission about the impact on health care facilities. Specifically, we seek comment and invite proposals that would promote partnership with public and private stakeholders to gather and analyze data on the needs, implications and impacts of the technology transitions on healthcare providers and their patients.

8. We (Still) Invite Your Feedback and Proposals! Connecting community anchor institutions : 107-108 We are interested in learning how to best leverage the support available from all of the Commission’s universal service programs to comprehensively serve the needs of rural communities, including their educational and health care needs. Experiments to fund modern networks in rural, high-cost areas from the Connect America Fund may serve to provide important information on the potential benefits and burdens of the technology transitions on healthcare providers and their patients… http://transition.fcc.gov/Daily_Releases/Daily_Business/2014/db0131/FCC-14-5A1.pdf

9. Current FCC Rural Health Care Programs Telecommunications Program Funds urban/rural rate difference for telecommunications services for rural HCPs Internet Access Program Provides 25 percent discount on Internet access services for rural HCPs Ends June 30, 2014, as participants transition to Healthcare Connect Fund Pilot Program Supports 50 state-wide and regional broadband HCP networks Participants transition to Healthcare Connect Fund as Pilot funds are exhausted Healthcare Connect Fund Supports broadband connectivity and broadband networks for eligible healthcare providers (HCPs) Provides a 65 percent discount on eligible services and equipment

10. Goals of Healthcare Connect Fund Increase access to broadband for HCPs, especially those serving rural areas Foster development and deployment of broadband health care networks Maximize cost-effectiveness of the program

11. FCC’s Healthcare Connect Fund • Who is eligible: Public and non-profit HCPs • Rural HCP sites – individually or as part of a consortium • Non-Rural HCP sites – only as part of a majority rural consortium • What is eligible: Connectivity -- covers broadband services, HCP-owned infrastructure, and network equipment • What is the support level: 65% discount (35% HCP contribution required) • When is support available: Now. Funding became available on January 1, 2014 (for existing Pilot projects, on July 1, 2013) • How to apply: Online through the Universal Service Administrative Company (USAC) 11 11 11

12. Benefits of Consortium Approach Creation and growth of broadband HCP networks Lower administrative costs Sharing of medical, administrative, and technical expertise Lower prices, higher bandwidth, and better quality connections Non-rural sites may participate in consortia and receive the discount, as long as they are in a consortium with a majority rural sites. Consortia can include ineligible health care provider sites, who pay their “fair share” but can be part of the network and benefit from negotiated rates Improved quality and reduced cost of healthcare through leveraging broadband connections in consortia

13. How Broadband Can Transform Healthcare • Pilot Program consortia used broadband connectivity to improve the quality and reduce the cost of providing healthcare. • Access by rural HCPs to medical specialists at larger HCPs through telemedicine • Enhanced exchange of electronic health records and coordination of patient care • Remote training of medical personnel • Reducing the cost of providing health care • Access to broadband can provide similar benefits for individual HCPs. • Examples taken from Staff Pilot Evaluation and Healthcare Connect Fund Order follow on next four slides.

14. Access by Rural HCPs to Medical Specialists at Larger HCPs through Telemedicine Bacon County Hospital (GA) A young woman’s life was saved because the local physicians were able to use their telemedicine connection to a specialist in Savannah, and as a result, administer the clot-busting drug TPA. Heartland Unified Broadband Network (IA, MN, NE, ND, SD, WY) Telemedicine enabled a rural critical access hospital to provide $24,456 in services locally that would otherwise have been provided elsewhere, including specialist ordered services such as bone scans, ultrasounds, x-rays, CT studies, and various lab tests. North Country Telemedicine Project (NY) Predicted that it will enhance its patient hospital revenue by $4.1 million due to increased retention of patients across five specialties- general surgery, cardiology, gastroenterology, oncology and pulmonology.

15. Enhanced Exchange of Electronic Health Records and Coordination of Patient Care • Sanford Health Collaboration and Communication Channel (SD, IA, MN) • Upgraded from T-1 connections to Ethernet services, which then enabled the project to roll-out EHRs. • EHRs enable this hospital, which has patients coming from as far as 150 miles away to a number of entry points, to treat patients more efficiently and effectively. • Patient outcomes are better because all patient information is centrally captured. • Heartland Unified Broadband Network (IA, MN, NE, ND, SD, WY) • Following the implementation of electronic Intensive Care Unit (e-ICU) services, HUBNet dropped the average number of days patients spend in ICU, thereby reducing costs, and has reduced the number of patient transfers to other hospitals.

16. Remote Training of Medical Personnel • Continuing medical education provides rural providers with increased learning opportunities and reduces their sense of medical isolation. • Palmetto State Providers Network (SC) • Twenty-five continuing education courses were offered to 457 health care providers within a 7-month period in 2011, and physician’s assistant students on rotation throughout the PSPN sites were trained remotely during July and August 2011. • Iowa Rural Health Telecommunications Program (IA, NE, SD) • Reported that the network and the telemedicine services provided over it have enhanced physician satisfaction and collegial support.

17. Reducing the Cost of Providing Health Care • Palmetto State Providers Network (SC) • Emergency Department psychiatry treatment costs dropped from $2,500 to $400 per patient, per day as a result of its tele-psychiatry program. As a result, it realized $18 million Medicaid savings. • Pennsylvania Mountains Healthcare Alliance (PA) • The transmission of clinical and financial information over their network reduced employee turnover because employees are now able to do transcription work from home. Since the network was implemented, the turnover rate for transcriptionists dropped from fifty to zero percent, saving the hospital approximately $20,000 per full time employee. • Adirondack Champlain Telemedicine Information Network (NY) • Anticipated $9 million in future operating cost savings as a direct result of the provision of tele-cardiology, tele-trauma, tele-mental health, tele-neurology, and tele-respiratory services.

18. What is supported? For all applicants: Broadband services Reasonable and customary installation charges Equipment necessary to make service functional Connections to off-site administrative offices and data centers Connections to research & education networks Consortium applicants also may receive support for: Equipment necessary for network Upfront charges for deployment of new or upgraded facilities, including dark fiber HCP constructed and owned facilities, if shown to be most cost-effective option

19. Funding Caps Cap on total funding for FCC Rural Health Care Programs, including Healthcare Connect Fund, is $400 million annually Cap for upfront payments in Healthcare Connect Fund is $150 million annually

20. Healthcare Connect Fund Support in 2013 as of 5/31/14 • Received 7,640 requests for eligibility. • Since January 1, 2014, 76 new consortia and 4,552 individual applicants have been approved to seek funding in HCF.    • Individual applicants have • requested $8.04 million • been committed $3.65 million • Consortia applicants have • requested $35.23 million • been committed $8.18 million • Recurring support = $8 million • Non-recurring support = $87,545 • Upfront expense support = $98,496

22. Additional Resources • For more information: • FCC Rural Healthcare website, http://www.fcc.gov/encyclopedia/rural-health-care • Healthcare Connect Fund FAQs, http://www.fcc.gov/encyclopedia/healthcare-connect-fund-frequently-asked-questions • USAC RHC Program website, www.usac.org/rhc • Pilot Program map, http://www.fcc.gov/maps/rural-health-care-pilot-program • Pilot Program Staff Evaluation, http://hraunfoss.fcc.gov/edocs_public/attachmatch/DA-12-1332A1.pdf • Questions: rhc-assist@usac.org

23. Thank You! Matt Quinn Director of Healthcare Initiatives Federal Communications Commission Email: matthew.quinn@fcc.gov Christianna Lewis Barnhart Acting Manager, Rural Healthcare Program Federal Communications Commission Email: christianna.barnhart@fcc.gov