Rosenworcel Remarks at American Telemedicine Association Policy Summit
COMMISSIONER JESSICA ROSENWORCEL
AMERICAN TELEMEDICINE ASSOCIATION FEDERAL POLICY SUMMIT
JUNE 28, 2013Thank you, Jonathan Linkous, for that kind introduction. Thank you also to the
American Telemedicine Association for inviting me to participate in today's Federal Policy
Now with this audience of health care experts, I feel duty bound to begin by offering my
credentials. I come from a family teeming with physicians. Count my father, father-in-law,
brother-in-law, and sister-in-law among them. I am the lowly lawyer in the bunch. Over
holidays when the table turns to talk of hospitals and HIPAA, I listen politely. But I admit that it
is not my realm. Because I know in their mind, somewhere I took a wrong turn, headed for the
legal life, and wound up in Washington.
But as good fortune would have it, I wound up at the Federal Communications
Commission. That means day-in and day-out I have the privilege of a front row seat at the
digital revolution. The opportunity to see the networks that are remaking our civic life and
commercial life. The opportunity to see the connectivity that is changing the ways we reach out
around the corner and across the world. It is also provides a prime vantage point to witness the
ways that telemedicine can revolutionize healthcare.
So let me start by telling you what I have seen.
In California, I saw how pediatric urologist Dr. William Kennedy and his team at Packard
Children's Hospital share their special expertise via video with patients many, many miles away.
In Alaska, under the leadership of Dr. Stewart Ferguson, I saw how village clinics well
beyond the last road mile, so remote they can only be accessed by airplane--can nonetheless
provide first-class care using a mix of broadband and store-and-forward technologies.
And back in here in Washington, at the Children's National Medical Center, Dr. Craig
Sable and his team showed me how pediatric specialists in their hospital can treat and diagnose
cardiac patients with broadband-enabled video links that reach across the country and in some
cases, around the world.
Now California, Alaska, and the District of Columbia are very different places. The
institutions I visited look different, feel different, and treat different populations. But they had
something in common: sheer optimism about the power of telemedicine.
I share their optimism. Even better, the numbers clearly show that lots of others do, too.
More than 10 million Americans directly benefited from telemedicine services last year. This is
double what it was only three years ago. More than 5 million Americans had their medical
images read remotely last year and 1 million Americans currently benefit from remote cardiac
monitoring for implantable devices. In hospitals, a full 10 percent of all intensive care mobile
unit beds now use telemedicine in some form. More than half of the states have telestroke
programs to help identify and administer time-sensitive treatment to stroke patients living in
rural areas. Add to these numbers the tens of thousands of mobile health applications available
on smartphones--and you quickly get the picture. Technology is changing the nature of
medicine and the way it is practiced in communities in urban areas, rural areas, and everything in
With the cost of healthcare in the United States projected to be nearly $3 trillion this year,
we should seize solutions that can reduce costs while also improving medical outcomes and
patient care. Telemedicine is one of those solutions.
Data from across the country make this clear. Telemedicine programs in Virginia have
reduced transport by 1.4 million miles per year. Staying home with remote monitoring devices
means avoiding longer hospital stays and reducing costs. In New Mexico, the Hospital at Home
program reduced costs by as much as 19 percent. But cost reduction, of course, is only part of
the equation. Improved patient care is essential. So we should take note when the University of
Virginia's High Risk Obstetrics Telehealth program reduced the incidence of preterm births by
25 percent. At the same time, this translates into real savings, considering the cost of an extreme
preterm birth is typically more than $40,000 a week.
All of this is impressive. But the best is yet to come. Imagine telemedicine aggregating
patients with rare diseases and linking them to specialists for treatment and participation in
clinical trials. Imagine how it can help keep local bonds strong in rural communities by fostering
aging in place. Imagine how it can facilitate the connection of patients to doctors that can meet
specialized language or cultural needs. These things are within reach.
With all this promise, then, the question becomes what can we do to expand upon the
current successes of telemedicine?
To answer this question, let me start with three things the FCC is doing. Then I want to
veer a little further afield and talk about telemedicine beyond the FCC.
First, let's start with the obvious. Telemedicine solutions require access to high-capacity
broadband networks. That's where the FCC comes in. This idea is not new or novel. In fact,
Congress charged the FCC with assisting with deployment to rural health care providers back in
the Telecommunications Act of 1996. Let's credit Congress with being ahead of the curve.
Seventeen years ago, big broadband was in its infancy. Dial-up was our online destiny. You and
I probably called the Internet the information superhighway. But Congress saw clearly that
better networks can mean better care.
So in the years following passage of this law, the FCC had a rural health care support
system in place. It provided remote hospitals and clinics with funds for advanced
communications. The program was used modestly, and demand for support was well, weak. So
over time we revised our policies at the margins, tweaked our paperwork. But demand did not
budge. We knew telemedicine was powerful--and Congress had given us a job to do. Back to
the drawing board. So a few years ago we tested some big changes in a pilot program--and this
past December we put a better version of them in place and made them permanent.
This is exciting. We have a new Healthcare Connect Fund that is part of the $400 million
the agency makes available annually to rural health care providers through its universal service
program. Under the program, eligible health care providers can apply to receive funding to
cover 65 percent of the cost of either broadband services or health care provider-owned
networks. Consistent with the law, eligibility is impacted by whether or not the health care
provider is located in a rural area. But both non-rural and rural health care providers can be
eligible for support if they apply as part of a consortium that has a majority of rural health care
providers. This makes good sense. Linking rural and urban providers means more access to
specialists. It means lower cost broadband services through bulk buying. It means less
We are proud of this new program and believe it is the start of something good. Funding
for existing pilot program participants begins a few days from now on July 1. Funding for new
applicants begins on January 1 of next year. I encourage you to learn more and participate.
Then tell us your stories. We want to always be on guard for ways to improve this program.
Second, the FCC is taking note of how spectrum can be put to totally novel health care
uses. Last year, the agency allocated airwaves in the 2360-2400 MHz band for Medical Body
Area Networks, or MBANs. It sounds like science fiction, but by using small, low-powered
sensors on the body, we can capture a wide range of physiological data. Information about blood
pressure, glucose, oxygen concentration in the blood, and other medical metrics then can be sent
along wirelessly to health care providers. This reduces the cost of patient monitoring. It frees
patients from being tethered to a messy jumble of wires and devices both in the hospital and at
home. It makes it possible for medical care that is more accurate, more patient-centered, and
more preventative. But MBANs are only one example. Going forward, we need to continue to
look for new ways spectrum-enabled activities can help improve health care.
Third, coordination. That sounds simple, doesn't it? But by my count, some 16 federal
agencies have a role in shaping telemedicine policy. That is a lot of seats at the table and a lot of
people at the party.
For our part, we are forging ahead at the FCC. We are locking hands and building
bridges with our federal colleagues. For instance, we have been part of a working group with the
Food and Drug Administration and the Office of the National Coordinator for Health
Information Technology. Together, we are producing a report on an appropriate, risk-based
regulatory framework for health information technology and mobile medical applications. We
want to promote innovation, protect patient safety, and avoid the time-worn problem of
We also have coordinated so that our new Healthcare Connect Fund works in tandem
with other federal initiatives. For example, the Affordable Care Act and the Health Information
Technology for Economic and Clinical Health Act both emphasize the use of electronic health
records. As a result, our Healthcare Connect Fund includes support for broadband connections
to off-site administrative offices and data centers, which in turn will support cloud-based
electronic health records.
So there you have it. Three things we are doing at the FCC: a new Healthcare Connect
Fund, a new focus on opportunities for enhanced care with spectrum, and a renewed commitment
to coordinate. Three things that I hope will foster even better telemedicine in the days ahead.
But now I want to veer off a bit and describe something outside my bailiwick at the FCC.
But it comes up in every single visit I have made to a major telemedicine facility--including in
California, Alaska, and Washington. So here it goes.
We can strive to do great things with telemedicine, but we will cut its promise short if it
is fenced in by state borders and old rules premised on local paperwork. States have played a
large role in the regulation of our health care system and physicians. Indeed, today, 69
jurisdictions are involved in licensing doctors in the United States. Before the advent of
telemedicine, the diagnosis, treatment, and care of patients almost always happened face-to-face.
But what if it doesn't? After all, with telemedicine patients may receive treatment across state
borders. This means medical professionals typically must comply with different licensing
requirements in multiple jurisdictions.
But licensing rules are only part of the story. State by state, insurance reimbursement
through Medicaid and private insurance companies vary based on state requirements. Moreover,
malpractice laws also vary, so malpractice insurance must be procured at the state level. The
added cost of compliance with so many individual state requirements can hinder the
development of relationships across state lines. This can cut patients off from multistate and
regional networks that can be both valuable and cost-effective. It can mean that however good
and smart our programs are at the FCC, they will never reach their full potential.
Add to all this that under federal law, reimbursement for telemedicine services for
Medicare patients is restricted to very limited circumstances. That means a great number of
patients that could otherwise benefit from telemedicine are missing out. And without the
promise of reimbursement for such a large segment of the patient population, this may keep
many health care providers from embracing telemedicine at all.
What can we do about it?
For starters, I think we should study the Servicemembers' Telemedicine and E-Health
Portability Act. It has helped streamline rules and foster the use of telemedicine across the
country by allowing all Department of Defense doctors to practice in any location in the United
States. Similar legislation has been introduced that would do the same streamlining for
physicians from the Department of Veterans Affairs. I hope as we move forward we keep these
efforts in mind. Because we need new ways to streamline cross-border licensing and practice
protocols for telemedicine. We should identify what works at the national level--and why. In
the meantime, we should encourage states to streamline their own requirements or form
reciprocity arrangements to help their residents reap the real benefits of telemedicine.
But even with these challenges ahead, I am an optimist. There are simply too many good
things we can accomplish with telemedicine. I even think my many relatives in medicine would
agree. Because digitization, cloud computing, broadband ubiquity, and new wireless services are
combining in such a potent way. We can seize this mix and make telemedicine an integral part
of modern medicine. And in the process, we can save lives, enhance patient care, improve
outcomes, and lower costs. That is an effort worth the fight--and I want the FCC to be a part of
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