What happens to telemedicine if we lose net neutrality?
The following is a guest post from Beatriz Mallory, SVP, managing director at healthcare marketing practice SensisHealth.
The Federal Communications Commission voted 2-1 on May 18 to review the rules that regulate internet service providers. Over the following 90 days it will collect comments from stakeholders and the public before drafting new rules that would give the ISPs more control over which information got priority on their networks, effectively ending “net neutrality.”
So, what happens to telemedicine without this oversight?
Rural and underserved communities with fewer choices of ISPs will likely receive diminished care, at slower speeds and higher cost, than patients in more urban, affluent communities according to net neutrality proponents in the healthcare industry.
Some provider groups see the situation as more dire. The American Academy of Pediatrics stated, “Establishing a system of paid prioritization is contrary to the health and well-being of infants, children, adolescents, and young adults.”
In 2015, the Obama administration enacted the “Open Internet Order” banning ISPs from blocking or throttling legal content. It also prohibits them from engaging in business arrangements where companies pay ISPs a premium to have their traffic prioritized, and gives the FCC the authority to police other practices it deems unfair or harmful to consumers.
Many internet users of all stripes are concerned that if the FCC loosens or eliminates rules preventing cable and phone companies from discriminating against website providers and/or content by charging bandwidth-related fees, websites in a paid “fast lane” will leave other sites in a slow lane. Unfortunately, the healthcare industry has not weighed in as vociferously as others, even though telemedicine, one of the most innovative and essential digital points of care, will be directly affected by Pai’s plans. This could jeopardize telemedicine’s patient user growth from 250,000 in 2013 to 7 million in 2018.
According to a RAND Corporation study released in March, nearly 88% of telehealth visits represented new users who wouldn’t have gone to a doctor otherwise. Yet the study indicates that cost per consultation is already higher than in-person visits – and that’s with the current net neutrality rules in place.
If the rules are lifted, and the FCC reclassifies ISPs as “common carriers” like any other utility, ISPs would be free to charge a premium fee to healthcare providers. Payers are unlikely to absorb these increased costs, so providers will need to determine how and when to pass along increased costs to patients.
This would be another barrier to access for patients who most need care.
Americans are interested in using telemedicine. American Well had Harris conduct two surveys online in late 2016 to measure consumer perceptions and experiences with telehealth. Among those who have a primary care provider (PCP), 65% are interested in seeing their PCP over video. Parents with children under 18 are even more likely to say they’re interested, with 74% interested in seeing their PCP through telehealth.
Healthcare executives are equally enthusiastic, with 83% of respondents to the American Telemedicine Association’s recent survey saying they are likely to invest in telehealth in 2017.
Despite this enthusiasm, elimination of the Open Internet Order will push more patients away from telemedicine. One third of Americans don’t have broadband service at home, and 60% say it costs too much. Paying even more for access will keep them out of care, or drive them into the most expensive point of care – the ER.
An open and unbiased internet is necessary to insure a future of American digital healthcare progress and startup innovation. Patients, doctors, and hospitals rely on the internet to manage health and business. Doctors not only see patients virtually, general surgeons in rural Pennsylvania are consulting with pediatric neurosurgeons in Texas during procedures. PCP’s now securely share their patients’ clinical information with other clinicians over the Internet, which patients can access if they have the means.
Normally, this progress in digital healthcare would be allowed to grow unencumbered and the challenges mentioned above could be eliminated with improved access. However, this progress is being threatened by newly deregulated, powerful, monopolistic-minded ISPs. This is the time for the healthcare industry to get out of neutral, and weigh in on net neutrality.