Expanding Telehealth Key to Care Access, But Tech Infrastructure Needs Upgrade

While policymakers appear keen to extend telehealth flexibilities and ensure expanded access to virtual care, US Sen. John Thune (R-S.D.) believes widespread technology infrastructure issues may hold up their efforts.

Thune, who serves as a ranking member of the Senate Commerce Committee's Subcommittee on Communications, Media, and Broadband and the Senate Republican whip, spoke at Sanford Health's Summit on the Future of Rural Health on Aug. 23. The discussion covered a wide range of topics, including telehealth policy, mental health access, and the enduring issues with internet connectivity and 5G adoption.

PERMANENT TELEHEALTH LEGISLATION STYMIED BY TECH HURDLES

The COVID-19 pandemic drove telehealth use to new heights primarily due to regulatory flexibilities that enabled the widespread adoption of the care modality. Though usage levels have fallen since their peak in 2020, they remain high. Those in the healthcare arena widely believe that the future of care delivery will involve more virtual options than before the pandemic.

But for this to become a reality, laws must be enacted to make the flexibilities permanent.

"The question is, yes, what do we do going forward?" Thune said at the virtual event. "Because the public health emergency isn't going to be in place forever. Right now, it's another 90 days or so into the fall…it [will] probably get extended for a while, but we need a long-term solution."

In July, the House of Representatives passed the Advancing Telehealth Beyond COVID-19 Act, which will extend pandemic-era telehealth flexibilities through 2024 if passed by the Senate and enacted into law.

But even as the bill moves through Congress, technology infrastructure issues must be addressed to support the widespread adoption of telehealth, according to Thune.

Data from the Federal Communications Commission shows that 14.5 million Americans lacked broadband access at the end of 2019. But that figure may have spiked to 42 million Americans in 2021, the independent research organization BroadbandNow revealed.

Over the years, the FCC has allotted millions of dollars to extend broadband access to Americans nationwide. But the funding does not always reach the areas that need it the most.

"A lot of funding that gets put into the federal pipeline that goes out, that's supposed to be extending service to unserved or underserved areas — a lot of times [that] gets spent [in]…places that already have high-speed internet services," Thune said.

To combat this issue, Thune, along with fellow Sens. Amy Klobuchar (D-Minn.), Jerry Moran (R-Kan.), and John Hickenlooper (D-Colo.), introduced the Reforming Broadband Connectivity Act last year to strengthen the FCC's Universal Service Fund (USF). The USF aims to support universal access to broadband and other telecommunications services and includes programs focused on rural communities.

"I hope that we will see some additional attention and focus given to ensuring that the FCC Universal Service Fund is adequately prepared and ready to make sure that we got the backbone out there to deliver the services that I think are going to be, one, in demand, [and] two, going to be…offered by a lot of our healthcare providers," Thune said.

Another area of focus for lawmakers is the expansion of 5G cellular technology, the fifth-generation technology standard for broadband cellular networks.

"[5G technology is] just that much faster when I talk — about a hundred times faster downloads," Thune said. "I mean, think about that. What that means for telehealth, think about what it means for distance learning."

This technology will need to be deployed widely in rural areas for those communities to reap the benefits of telehealth, he added. But the infrastructure required for 5G differs from the one necessary for 4G. The latter transmits signals from cell towers, some of which can be remotely located. On the other hand, 5G leverages small cell technology and requires small cell stations to be placed in 5G-capable areas to ensure the signals can be sent reliably.

"So, you've got to have rights of ways and easements and that sort of thing," Thune said. "And for me at least, and this is…based on feedback I received from those who are trying to install these types [of technologies] and build these networks out across the country. The key is trying to get the process expedited to build out the networks. It takes so long to get the sighting, the permitting, the easements, the rights of way. And you've got to have local governments that are working as partners with you to make all that possible."

Thune is working with US Sen. Brian Schatz (D-Hawaii) on a bill to streamline the process for building out 5G networks so they can be deployed faster.

"I'm a big believer in distributed power, in keeping local governments in charge of a lot of the decision-making with respect to these types of networks being built, but they shouldn't be able to sit on them for years at a time," he said.

TELEMENTAL HEALTH WILL REMAIN ESSENTIAL

The mental health crisis in America is one of the driving forces behind the efforts to expand telehealth access.

"This was an unmet need, I think, before the pandemic, but we've seen just the need for mental health services has skyrocketed," Thune said. "And so, as a nation, as a provider group, policymakers, how do we deal with that?"

The crisis is especially prominent among children and adolescents, spurred by the COVID-19 pandemic. According to Centers for Disease Control and Prevention data, between March and October 2020, the proportion of mental health-related emergency department visits increased by 24 percent among kids aged 5 to 11 and 31 percent among adolescents aged 12 to 17 compared with 2019.

Telehealth can help close gaps in mental healthcare. Monthly telehealth usage data shows that mental health remained the most common telehealth diagnosis nationally throughout the pandemic.

Further, the care modality can help extend access to behavioral healthcare among American youth.

Acknowledging virtual care's key role in addressing mental health needs, Thune and three other senators released a discussion draft of telehealth policies for mental healthcare initiatives in May. These policies include removing the Medicare requirement for an initial in-person visit before a telehealth visit and providing benefit transparency for Medicare beneficiaries.

Further, Thune believes that incentives must be offered to encourage people to enter the mental health industry as counselors and providers to combat the growing workforce shortage.

"Part of [the solution] is just having more providers, honestly, counselors," he said. "And that means figuring out ways to get more people to enter the field. And so, a lot of what's being done by the Senate Finance Committee is trying to figure out what are those types of incentives that can be offered to encourage people to go into the field."

In the interim, telehealth can help extend the mental health workforce. But, as stated above, the technology infrastructure needs significant upgrades to ensure access for all.

According to Thune, enhancing the technology infrastructure and advancing telehealth use will remain high on the policy priority list for lawmakers, as virtual care has become an "increasingly important engine driving healthcare solutions."