As the Federal Communications Commission (FCC) is considering how to support telehealth in rural areas, the AAFP offered recommendations to help ensure that practices receive the support they need and patients have the benefit of longitudinal care from a primary care physician.
The FCC published a proposed rule(www.gpo.gov) in the Jan. 3 Federal Register with the goal of expanding telehealth services in areas of need. The proposal includes changes on a wide range of issues, from the annual budget of the Rural Health Care (RHC) program to distribution of funding based on community needs.
In a Jan. 31 letter(3 page PDF) to FCC Secretary Marlene Dortch that was signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., the Academy said telehealth has the potential to increase access to care, facilitate care coordination and ensure that patients receive timely care in areas where health facilities are limited.
"It is the policy of the AAFP to support expanded use of telehealth and telemedicine as an appropriate and efficient means of improving health when conducted within the context of appropriate standards of care," the letter stated.
Federal officials have been hesitant to support expansion of telehealth partly out of concern that greater use of the technology could be driven chiefly by financial goals rather than by the desire to improve care coordination or health outcomes. The letter highlighted this concern.
"A policy which only supports the continuance or expansion of direct-to-consumer telehealth services would lead to care provided in silos, which can fracture care and increase total cost of care," the letter stated.
Instead, the FCC should focus on supporting continuity of care, particularly for those who practice in rural areas. For example, the AAFP said telehealth could help a rural primary care physician coordinate a remote subspecialist patient consult that might take weeks or months to schedule as a face-to-face visit.
The FCC is considering increasing the RHC budget, which has been capped at $400 million since 1997. According to the letter, the FCC itself provided an example of this by noting that if it had adjusted the $400 million cap annually for inflation each year from 1997 forward according to accepted measures of inflation, "the program cap would have been approximately $571 million for FY 2017." The AAFP agreed that the cap should be adjusted for inflation and advised the agency to consider technology price fluctuations, as well.
Another change the FCC is considering is to allocate funding based on the economic needs of the rural population served by a particular practice, a move the AAFP strongly supports.
The FCC sought input on the use of income eligibility as a measure of economic need when prioritizing telehealth expenditures, suggesting Medicaid as one possibility. The AAFP pointed out that Medicaid eligibility varies widely by state and suggested that an adjusted gross income standard be adopted instead.
"We support the position that inequities of payments to rural hospitals should be abolished, and that the AAFP and other stakeholders make reasonable efforts to ensure that these inequities be discontinued to eliminate these disparities in access to quality care for all populations," the letter stated.
And although telehealth can help with patient access, the AAFP emphasized the need for a long-term solution that includes training and recruiting more physicians to work in rural areas.
"While efforts to meet physician shortages in rural areas have improved the situation, there continues to be a shortage of physicians for rural areas," the letter stated. "A balanced and cooperative effort among those involved in medical education is needed to promote rural practice."
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