AAFP Urges Better Broadband for Telehealth, Health Equity
Academy President Tells Senators Access Is a Social Determinant of Health
October 12, 2021, 1:35 p.m. News Staff — In sharp testimony before a Senate subcommittee last week, the Academy advised lawmakers that the pandemic-driven ramping up of telehealth was an incomplete success story awaiting its next chapter: robust broadband access.
“Broadband access must be recognized as a social determinant of health,” AAFP President Sterling Ransone, M.D., of Deltaville, Va., said in written testimony to the Senate Commerce Committee’s Subcommittee on Communications, Media and Broadband. He also testified virtually at the Oct. 7 hearing, titled “State of Telehealth: Removing Barriers to Access and Improving Patient Outcomes.”
“The COVID-19 pandemic has underscored the strong link between digital equity and health equity,” he added, citing studies that estimate 42 million Americans are unable to buy broadband internet service, with rural Americans 10 times likelier than urban residents to lack that access.
“I have a patient with congestive heart issues who drives more than an hour each way to see me and who would benefit tremendously from this technology, but we can’t use it because of poor bandwidth,” Ransone told the subcommittee.
“Having practiced in a rural community for more than 20 years with my wife, who is a pediatrician, I have seen firsthand how telehealth can enhance the patient-physician relationship; increase access to care; improve health outcomes by enabling timely care interventions; and decrease costs when utilized as a component of, and coordinated with, continuous care. Telehealth services during the pandemic have allowed patients and families to maintain access to their usual source of primary care, ensuring care continuity.”
Story Highlights
To build on that success — and to connect more patients and families to family physicians — will require significant improvements to broadband infrastructure and related resources, he added. The Academy’s testimony included detailed guidance on how to achieve those aims. It called on policymakers to focus spending on
- ensuring universal access to affordable broadband services for individuals and health care professionals;
- funding programs that provide end-user devices (such as tablets), digital literacy training and patient technical assistance;
- expanding federal telehealth programs to support small physician practices; and
- ensuring that telehealth-related data collection and evaluation include race, ethnicity, gender, language and other key factors.
The Academy’s testimony expressed support for existing federal broadband funding efforts and urged their expansion, particularly the FCC’s Rural Health Care and Lifeline programs.
Noting that small physician practices face telemedicine startup costs of $400 to $3,000, as well as recurring subscription or transaction fees, Ransone’s testimony asked for increased support for telehealth adoption. The Academy said that the FCC’s Connected Care Pilot Program, designed to help cover telehealth expansion costs for some practices, should be extended and expanded. (Announcement of the program’s latest round of selections is imminent.)
To increase health equity, the AAFP called for “the creation of a pilot program to fund digital health navigators; development of digital health literacy programs; and deployment of digital health tools that provide interpretive services at the point of care, are available in non-English languages, easily and securely integrate with third-party applications, and include assistive technology.”
The AAFP also used the hearing to again emphasize that physicians must be empowered to choose which modality best serves their patients’ immediate needs.
“No two patients or cases are alike,” Ransone testified, “and I should be able to choose how to care for them based on my clinical judgement, not based on arbitrary insurance rules.”
“There may be times that an old-fashioned phone call is the best way for a clinician to treat a patient,” he said. “Therefore, it is critical to preserve access to audio-only telehealth services provided by a patient’s usual source of care."
The testimony echoed the Academy’s detailed remarks to the Senate Finance Committee this past May, in which the AAFP said Medicare should cover audio-only evaluation and management services beyond the public health emergency to ensure equitable access to care. The Academy last month called on CMS to add telephone E/M codes to the Medicare telehealth services list on a Category 3 basis, as well as implement a more permanent solution for audio-only services, in the 2022 Medicare physician fee schedule final rule.