COVID-19: Digital Chasm Impacts Needed Telehealth Expansion

COVID-19 is exposing a digital divide between the have’s and have-nots.

The coronavirus pandemic is impacting more than the health and mental health of entire populations. Social distancing and sheltering in place have put a massive drain on broadband and Wi-Fi service. While telehealth may be viewed as a fix for some populations, programs, and providers, a number of challenges stand in the way of full implementation. The gap between the have’s and have-nots is ever-widening, with growing numbers of persons at risk of factors associated with the social determinants of health (SDoH) across the globe: seniors, children, and adults with disabilities, along with residents of rural and low-income socioeconomic areas, to name a few. Those exposed to, and working with, the SDoH face not only a digital divide but a massive digital chasm.

Poor, limited, or insufficient Wi-Fi access was a pre-COVID-19 reality. Data has shown that the neediest persons have often accessed electronic medical records (EMRs), virtual health, and patient portals less of late, due to a lack of digital devices, use of outdated devices or platforms, health and language literacy challenges, and poor technology proficiency.

Of further concern are service gaps arising due to the following:

• Federally Qualified Health Centers (FQHCs), nonprofit community agencies, and safety-net hospitals often lack telehealth access for some programs and providers (as in behavioral health).
• Lack of licensure portability leaves health and behavioral practitioners with interstate practice limits. The Centers for Medicare & Medicaid Services’ (CMS’s) recent announcement temporarily expanded practice across state lines by some licensed professionals, though the effort fell grossly short, as it only applied to physicians, nurse practitioners, hospice nurses, and occupational therapists. While a critical void will be addressed by this action, many key licensed personnel were left out, including those working in disciplines involved in case management, social work, behavioral health practitioners, physical and speech therapy, and respiratory therapy, to name a few. These omissions are especially surprising considering the recent emphasis on traumatized frontline healthcare professionals in desperate need of mental health support.
• Much of the mental healthcare rendered to the neediest populations in the U.S. is provided by social workers, counselors, licensed marriage and family therapists, and others, all of whom were excluded from the CMS language.

Federal efforts were announced by the U.S. House of Representatives in the form of new COVID-19 legislation, including $2 billion dedicated to expand broadband for coronavirus telehealth services. The money would bolster the Federal Communications Commission’s (FCC’s) Healthcare Connect Fund Program, which currently subsidizes 65 percent of broadband costs for eligible rural healthcare providers. If the bill is passed, the subsidy would rise to 85 percent, streamline administrative requirements, and expand the program to rural, urban, and suburban healthcare providers. This legislation would also include temporary and mobile facilities being set up to deal with the pandemic.

Time will tell how this important funding will play out, but suffice to say, it would make a considerable difference for all healthcare consumers, especially populations at risk of the SDoH. This week’s Monitor Mondays weekly listener’s survey explored telehealth access across the industry. The results reflected just how far healthcare organizations must go before ensuring appropriate telehealth access for those persons, populations, and programs that need it the most. View the survey results here.

Programming Note:  Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting this coming Monday during a special 60-minute townhall edition of Monitor Mondays, 10 -11 a.m. EST.