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March 2021

SC Gov. McMaster sends $6 million to establish free computer labs in internet deserts

By News

Governor Henry McMaster discusses new education funding. The new funding is meant to help respond to immediate problems related to the coronavirus and to help with economic recovery.

Updated March 30, 2021 03:24 PM

South Carolina will spend $6 million of its federal COVID-19 aid to help tackle broadband deserts across the state.

S.C. Gov. Henry McMaster awarded the money from the Governor’s Emergency Education Relief Fund to the University of South Carolina, which will partner with Benedict College to create eight free-to-use Apple computer labs across South Carolina, according to a Tuesday statement from the governor’s office.

“The pandemic has made it abundantly clear that internet access is not a luxury but a necessity for millions of South Carolinians,” McMaster said in a statement. “The strategic placement of these labs will bolster South Carolina’s premier workforce training efforts by giving our communities and people access to resources they need to expand participation in our state’s growing economy.”

During a press conference, McMaster said the initiative was part of a project aimed at expanding broadband internet access across the state. He said he is working with the state’s congressmen to secure additional funding for broadband expansion.

The computer labs’ locations were chosen so they would be near historically Black colleges and universities, facilities in the state Technical College System and local school districts that may need them. There will be one lab located in Columbia’s BullStreet District and another at Benedict College. Those facilities will have an operating budget of $2 million.

“We are pleased to partner with the University of South Carolina to expand educational technology access to communities around the state,” Benedict College President Roslyn Clark Artis said in a statement. “Benedict College remains fully committed to narrowing the digital divide for underserved communities in our state. This is a tremendous step in the right direction.”

Seven other labs, with operating budgets of $571,429 each, will be located at six of USC’s Palmetto College and regional campuses, according to the statement. All of USC’s Palmetto College campuses chosen for the project are located within 15 miles of a broadband desert.

“As the state’s flagship institution, the University of South Carolina is committed to enhancing statewide economic and workforce development initiatives,” USC President Bob Caslen said in a statement. “By providing access to Apple’s coding curriculum and emphasizing creative learning, this partnership is a game changer for our state. The educational programs and training at these learning centers will give South Carolinians relevant skills that are in high demand in today’s economy. We are proud to partner with Governor McMaster, Apple and Benedict College in this mission by investing in underserved communities across the state.”

The labs are free to use by members of faculty, staff, students and community members. Availability will be advertised in each community. Officials expect to get some facilities running within the next 90 days.

The labs will be paid for through the CARES Act, which was a coronavirus aid package passed by Congress in March 2020. Each state received money for emergency education relief spending which the governor may direct. South Carolina received $48 million.

Tuesday’s announcement gives McMaster another path to provide COVID-19 aide to the state’s HBCUs, which are all private but for one.

McMaster initially pushed to spend $32 million of the funds on one-time tuition grants of up to $6,500 per students who attend K-12 private schools. McMaster’s plan was shot down by the State Supreme Court. McMaster’s initial plan also allocated $2.4 million for private colleges, including HBCU’s, but that money was also frozen by the court decision.

Source:  The State

Lindsey Graham, Tim Scott introduce broadband expansion bill

By News

If Lindsey Graham, Tim Scott and Jim Clyburn get their way, more South Carolina residents may soon be connected to the information superhighway.

Graham and Scott introduced an act late last week that would expand broadband access to underserved rural areas.

“There are places in South Carolina you might as well be on the moon when it comes to getting high speed internet service,” Graham said. “All South Carolinians should be able to utilize the educational, telehealth and business benefits of accessible and affordable broadband. There is bipartisan support for expanding broadband access, and our legislation dramatically improves access in rural and underserved areas.”

“Connectivity is absolutely essential for South Carolina families and businesses,” Scott said. “Increased broadband access means more opportunity for underserved and rural communities, positively affecting everything from education and health care to business and workforce development.”

The act will provide $20 billion for broadband infrastructure utilizing fiber-optic cables, wireless, and 5G technologies, use a reverse auction method to provide top-quality broadband service at the lowest price for the American taxpayer, and base a state’s funding on their unserved (no internet access at all) and a percentage of their underserved populations to distribute funds to the areas of greatest need like rural America and Opportunity Zones.

More than 650,000 citizens lack internet or have adequate broadband speed across South Carolina, and nationally, this number nears 20 million. The State Fix Act aims to close that gap and ensure every American is able to reach their full potential and access life-changing tools to better their lives, families and communities.

Clyburn and Minnesota Sen. Amy Klobuchar introduced a broadband expansion bill in mid-March.

D.C. roundup: S.C. senators push broadband; Ossoff plan passes; Biden slams Ga. law

By News
Published: Mar. 26, 2021 at 3:21 PM EDT

WASHINGTON – South Carolina Republican Sens. Lindsey Graham and Tim Scott have introduced a bill designed to expand broadband internet access to underserved rural areas nationwide.

The State Fix Act would provide $20 billion for broadband infrastructure utilizing fiber-optic cables, wireless and 5G technologies, according to Graham spokesman Toby Tyler.

“Connectivity is absolutely essential for South Carolina families and businesses,” Scott said. “Increased broadband access means more opportunity for underserved and rural communities, positively affecting everything from education and healthcare to business and workforce development.”

The bill also uses a reverse auction method to provide “top-quality broadband service” at the lowest price for taxpayers and bases a state’s funding on their unserved and a percentage of their underserved populations to distribute funds to the areas of greatest need like rural America and Opportunity Zones, he said.

“There are places in South Carolina you might as well be on the moon when it comes to getting high speed internet service,” said Graham. “All South Carolinians should be able to utilize the educational, telehealth, and business benefits of accessible and affordable broadband. There is bipartisan support for expanding broadband access, and our legislation dramatically improves access in rural and underserved areas.”

Unserved communities are defined as those with no internet access while underserved are defined as those with low-quality service.

Senate backs extension of Paycheck Protection Program deadline

WASHINGTON – The U.S. Senate on Thursday passed legislation Georgia Sen. Jon Ossoff co-sponsored to extend the Paycheck Protection Program deadline to the end of May. Without action on this legislation, the program would have expired in just days.

The PPP Extension Act of 2021 passed the U.S. House last week and is now expected to be signed into law by President Biden before the end of the month.

“Passage of this bill is a huge victory for Georgia’s small businesses, who can now apply for PPP loans through May,” Ossoff said. “Any small businesses with questions about accessing this aid should contact my office.”

The legislation extends the deadline for small businesses to apply for a PPP loan from March 31 until May 31, and will give the Small Business Administration until the end of June to process and approve applications.

The PPP program was first passed last year as part of the CARES Act. Since then, small businesses in Georgia have received more than 260,000 loans to the tune of nearly $19 billion, allowing them to stay afloat during the pandemic.

By the end of the month, the program is estimated to have between $25 to $65 billion remaining.

Biden slams Georgia’s new voting measures

WASHINGTON – Democratic President Joe Biden on Friday issued a statement opposing Georgia’s newly signed voting legislation.

The Republican-backed measure places new restrictions on voting by mail and gives the legislature greater control over how elections are run.

Democrats and voting rights groups say the law will disproportionately disenfranchise voters of color.

It is part of a wave of GOP-backed election bills introduced in states around the nation after former President Donald Trump stoked false claims that fraud led to his 2020 election defeat.

Here’s Biden’s statement:

More Americans voted in the 2020 elections than any election in our nation’s history. In Georgia we saw this most historic demonstration of the power of the vote twice – in November and then again in the runoff election for the U.S. Senate seats in January. Recount after recount and court case after court case upheld the integrity and outcome of a clearly free, fair, and secure democratic process.

Yet instead of celebrating the rights of all Georgians to vote or winning campaigns on the merits of their ideas, Republicans in the state instead rushed through an un-American law to deny people the right to vote. This law, like so many others being pursued by Republicans in statehouses across the country is a blatant attack on the Constitution and good conscience. Among the outrageous parts of this new state law, it ends voting hours early so working people can’t cast their vote after their shift is over. It adds rigid restrictions on casting absentee ballots that will effectively deny the right to vote to countless voters. And it makes it a crime to provide water to voters while they wait in line – lines Republican officials themselves have created by reducing the number of polling sites across the state, disproportionately in Black neighborhoods.

This is Jim Crow in the 21st Century. It must end. We have a moral and Constitutional obligation to act. I once again urge Congress to pass the For the People Act and the John Lewis Voting Rights Advancement Act to make it easier for all eligible Americans access the ballot box and prevent attacks on the sacred right to vote. And I will take my case to the American people – including Republicans who joined the broadest coalition of voters ever in this past election to put country before party. If you have the best ideas, you have nothing to hide. Let the people vote.

Georgia Gov. Brian Kemp responded:

“It is obvious that neither President Biden nor his handlers have actually read SB 202, which I signed into law yesterday. This bill expands voting access, streamlines vote-counting procedures, and ensures election integrity. There is nothing ‘Jim Crow’ about requiring a photo or state-issued ID to vote by absentee ballot – every Georgia voter must already do so when voting in-person. President Biden, the left, and the national media are determined to destroy the sanctity and security of the ballot box. As Secretary of State, I consistently led the fight to protect Georgia elections against power-hungry, partisan activists. As Governor, I won’t back down from keeping Georgia elections secure, accessible, and fair.”

Copyright 2021 WCSC. All rights reserved.

How Vaccine Registration Exposed the Reach and Limits of Broadband Access in SC

By News

Click Here to Listen to the story

Getting a COVID-19 vaccine appointment requires going online. But plenty of South Carolinians are not connected.

At the end of March, 2021, COVID-19 has killed more than 9,000 people in South Carolina, and almost 8,000 of them are people above the age of 60.

Reconcile that with the Pew Research Center’s findings that once above the age of 60, access to and ownership of smartphones or any device connected to the internet drops sharply as age increases.

Where this overlaps dangerously is in the middle of the COVID vaccine rollout, which requires residents to register through their phones, tablets, or computers. In a state where broadband access is being addressed more urgently by federal and state officials, huge parcels of South Carolina between Newberry and Jasper counties still have zero access to the internet, according to coverage maps by Palmetto Care Connections (PCC), a nonprofit advocate for equitable and wide-reaching broadband access in the state.

Kathy Schwarting, CEO of PCC, says that this puts residents – particularly rural seniors – in a bad spot.

“There’s the access issue,” Schwarting says. “Whether or not your area even has the ability to have internet. If you live out in the country, outside of the city limits, you may not even have fiber; and it’s very expensive to run it.”

But there’s also an age issue, remember. The Pew study shows that in 2017, the last year data is available, 67 percent of seniors were on the internet but 51 percent had access to broadband. Those numbers are likely a combination of choice and circumstance and may have changed in the intervening years, but there are, nevertheless, seniors who are simply not connected, at a time when the way to get registered for a COVID vaccination is online.

Schwarting has an aunt in her 70s who wanted to get vaccinated and had to call the South Carolina Department of Health and Environmental Control (DHEC) on the phone. The department initially told her she needed to sign up online, but Schwarting’s aunt has no computer and no internet-capable phone.

Schwarting says DHEC brought her aunt into an office and registered her in person. And while she’s happy it worked out for her aunt, Schwarting knows not everyone who’s offline will be able to do that. For rural seniors in particular, physically getting to a DHEC office could be a near impossibility.

Schwarting says several seniors without email addresses or even a connection have enlisted help from their children and grandchildren to register. For those who can get that kind of help, great, but again, she says, not everyone has someone connected whom they can call upon for help.

Cost, of course, is another issue. Even with access to some kind of reliable internet, it can be expensive. High-speed internet, which is often needed to navigate websites these days, is considered anything above 25 megabytes per second. Some plans in South Carolina run at 300mbs. The more mbs, the more money.

Monthly plans for low-income residents can start at $10 (or in some cases be essentially free). Some providers temporarily expanded eligibility to broadband because of the pandemic.

AT&T, one of the major providers in the state, did this. Lead Public Relations Manager Megan Daly said in a statement to South Carolina Public Radio that the company’s Access from AT&T program was offered to households participating in the National School Lunch Program and Head Start, “for $10 a month or less. Also, for a limited time, customers at locations with available AT&T Internet speeds above 10 Mbps may be eligible for a speed upgrade up to 25 Mbps.”

But if you don’t qualify for a low-income plan, broadband service can be pricy. It’s not unusual for South Carolinians to have plans costing around $75 a month in some well-connected areas. And, of course, plans expanded because of the pandemic will not be permanent, which, Schwarting says, could become problematic for unconnected lower-income residents looking to access medical records or find work after life moves past COVID’s disruption.

“If you are living paycheck-to-paycheck,” she says, “and you are trying to balance getting your medications, paying your light bill, paying your mortgage, making sure you have groceries, $75 is an awful lot of money. And [a $15] increase is a lot of money in a house where they don’t have extra money.”

According to BroadbandNow, South Carolina ranks 31st among U.S. states in high-speed connectivity, and about 53 percent of residents have access to a wired, low-price plan.


Connecting with the Unconnected: ‘Word of Mouth is Powerful’

An unexpected side-effect of the pandemic is that for as much as it put a spotlight on the need for technology access, it also reminded us that we still need analog options for getting in touch with people in a crisis.

Social media is the favored distribution method of health agencies, social services workers, news companies, and whoever else wants to get the word out about something. The reach is immense and immediate, but it does zero good for anyone who isn’t connected.

“Boots on the ground,” says Davia Smith, PCC’s director of education. “Social media works for some but it doesn’t work for all.”

Smith says that meeting people where they live – the grocery stores, churches, pharmacies – is the key to getting through to communities that might be cut off. That includes poor communities, communities of color, and rural neighborhoods, which all share something important to remember – a tendency to trust most in people they already know personally.

Getting to people in these communities is a clearly hefty task. But Smith says it’s necessary, especially in light of the continuing disappearance of one particular source of information.

“You have some communities that no longer have a local newspaper,” she says.

And even in places where local papers still exist, they are usually weeklies, which Smith says can create troublesome lags when people need to receive urgent information. So social and health workers, she says, need to ramp up their alternatives for how to get information to residents, and need to stop thinking that a website or an app solves every problem.

“We can’t stay behind the computer screen and expect everything to get done,” she says. “Word of mouth is powerful.”

DHEC, for its part, appears to have learned this lesson some.

In a statement, DHEC said:

We work to get current messaging to people who don’t rely on the internet for their news and information by way of:

  • signage at gas stations (targeted rural areas)
  • billboards (target rural areas)
  • advertisements in every weekly newspaper in the state
  • radio PSAs
  • TV PSAs
  • direct mailers
  • ongoing partnerships with local organizations that promote our messaging within their communities
  • continued partnerships with our state’s faith-based organizations to help share important information and resources
    • We partner with the nonprofit Hold Out The Lifeline (HOTL) to support grassroots statewide efforts directed toward African American churches and community groups. Among the many services offered, HOTL is conducting virtual briefings, distributing some of DHEC’s hardcopy resources and materials, and distributing PPE (face masks, hand sanitizer, gloves etc.) HOTL also provides church leaders with a toolkit to help them plan educational sessions that help inform their members about COVID-19 and COVID-19 vaccine. In January alone, it’s estimated that HOTL reached nearly 30,000 congregants with current DHEC messaging.
  • information at public transit hubs
  • shared information with the S.C. Department of Commerce and DHEC’s regulated business community to share with employees (breakroom signage and take-home literature)
  • sharing information and resources with the S.C. Commission for Minority Affairs, S.C. Department of Aging, Office of Rural Health, S.C. Department of Employment and Workforce, AARP, PASOS, housing authorities, public transportation systems, etc., to share current key messaging and phone numbers for accessing additional information.

Smith sympathizes with anyone trying to get real information out to communities that aren’t as well-connected. She says that between misinformation, constant updates of real information about what’s safe or where and when a vaccination event will happen, and the sheer volume of information hitting people (especially, ironically, the connected), getting good information through to residents is a tall task, but one that demands getting done right.

She says that as tech access becomes more ubiquitous, it will be important to remember that tech is not a Messiah, but a tool.

“I remember when stores … put in the U-Scan™ registers, and it was like, ‘Technology is going to take everyone’s job,” she says.

That didn’t happen, of course, and that’s her point.

“COVID has shown us that technology is a useful tool, but it’s not going to replace everything,” she says.

Efforts to Expand Access

One positive thing about the pandemic is that its main lesson about internet access – that it’s not a luxury anymore, but a necessity – appears to have gotten through to lawmakers who could do something about it.

Both of South Carolina’s U.S. Senators, Lindsey Graham and Tim Scott, Republicans, co-sponsored the Governors’ Broadband Development Fund, along with Sen. Mark Warner, Democrat, of Virginia. In December, the Federal Communications Commission granted the measure $121 million to expand rural broadband in South Carolina. The bill aims to get access to almost 109,000 homes that otherwise, according a statement Graham made, “might as well be on the moon when it comes to getting high-speed internet service.”

In mid-January, the outgoing Trump administration announced a $1.6 million grant to the Lancaster Telephone Company to deploy a fiber-to-the-premises network to connect 5,574 people, 20 businesses, 17 farms, and three educational facilities to broadband in Lancaster and Chester counties.

While measures like these certainly can help, South Carolina still has quite a way to go. The State newspaper reported last June that connecting all of South Carolina could be an $800 million endeavor. An ambitious plan introduced by U.S. Rep. and House Majority Whip Jim Clyburn (D, SC-6th), the Accessible, Affordable Internet for All Act, looks to invest $100 billion to build high-speed broadband infrastructure in unserved and underserved communities all over the country.

That bill was introduced last June and is making the rounds among the Biden administration’s American Rescue Plan.

And South Carolina’s state leaders have looked to tackle the issue of broadband access as well. In September, Gov. Henry McMaster signed the GREAT (Growing Rural Economies with Access to Technology) program into law. It looks to set the stage for a codified broadband access law in the state.

And the state’s 2021 budget features a $30 million safeguard to expand rural broadband to schools and businesses.

All of this is good news to guys like Graham Adams, CEO of the South Carolina Office of Rural Health (SCORH), who says that one of the pandemic’s few positives is the attention broadband access to rural America has gotten.

“[It’s] a much more recognized problem,” Adams says. “There’s a lot more attention on the lack of broadband in rural communities. The whole world was thrown into telecommuting and tele-learning; we all gained a greater appreciation for the importance of connectivity in the home.”

Something Adams hopes people in general come to understand better as access accelerates is that rural communities do want broadband. He says it’s not a matter of not wanting so much as a matter of simply not having access nor the ability to pay for it.

For now, he is glad to see progress being made, including in efforts like the joint SCORH, PCC, South Carolina Rural Innovation Network effort to map access points in Barnwell and Williamsburg counties. Those are two areas plagued by lesser tech access and lesser tech literacy, which Adams also says needs to be a major component of broadband expansion – because tech access won’t do anyone any good if no one can afford it and if no one knows how to use it.


A Small Data Snapshot

The caveat with this section and its accompanying graph is, don’t try to apply it too broadly. But as a way of illustrating a piece of the intersection of age, access, and vaccination, the data points do show a couple interesting things, as of March 26, 2021.

vax graph.jpg
A small look at three poorly wired counties and three well-wired counties in South Carolina.


Allendale, Aiken, and Bamberg counties, all mostly rural, have some of South Carolina’s largest areas without internet coverage; they each also have, according to data from the South Carolina Fiscal Affairs Office, senior populations above 20 percent – and, according to data from DHEC, have higher rates of death from COVID compared to three of the most connected counties in the state, Charleston, Greenville, and York. All three of these counties have senior populations below 20 percent.

While the dataset is too small to extrapolate any sweeping trends, there are also some correlations between how wired a county is and the percentage of that county’s residents who have been vaccinated at least once. Only York County, which is highly connected but has a relatively low vaccination rate, stands apart.

Addendum, March 26, 2021: On the day this story published, U.S. Senators Lindsey Graham and Tim Scott of South Carolina announced the $20 billion State Fix Act to build 5G fiber infrastructure in underserved rural communities.

House Legislation Would Make Telehealth for PTs and PTAs Permanent in Medicare

By News

If signed into law, the APTA-backed bill would achieve a major association goal. Contact Congress now to voice your support.

Informed by lessons learned during the COVID-19 pandemic, a bipartisan group of lawmakers in the U.S. House of Representatives has introduced APTA-backed legislation that would make payment for services delivered via telehealth a permanent option for PTs and PTAs participating in Medicare. If passed into law, the legislation would represent a major shift in payment policy long advocated by APTA.


Known as the Expanded Telehealth Access Act (H.R. 2168), the bill was initially sponsored by Reps. Mikie Sherrill, D-N.J., and David McKinley, R-W.Va. The proposed legislation rapidly gained additional support from both parties, and by the time of its introduction it included 14 additional original cosponsors. The association is urging all PTs, PTAs, students, patients, and other supporters to contact members of Congress by way of the APTA Patient Action Center to voice their support for the new bill.

Essentially, the bill would instruct the U.S Centers for Medicare & Medicaid Services to permanently adopt what is a temporary waiver of restrictions on payment for telehealth delivered by PTs and PTAs, occupational therapists, occupational therapy assistants, speech-language pathologists, and audiologists. The Secretary of Health and Human Services also would be allowed to further expand the list of authorized telehealth providers.

The inclusion of PTs and PTAs as authorized to provide services via telehealth to Medicare beneficiaries has been a longtime advocacy focus for APTA, dating back years before the pandemic triggered the CMS decision to invoke so-called 1135 waivers to allow for payment.

In a press release announcing the introduction of the bill, the primary cosponsors point to the effectiveness of telehealth during the pandemic as an indication that the approach can work for PTs, OTs, and other providers.”During the COVID pandemic, healthcare providers adapted and provided telehealth services to serve the needs of millions of vulnerable Americans,” said Rep. McKinley in the release. “Telehealth services have been beneficial to the health and well-being of America’s seniors and after the public health emergency ends, it’s crucial that critical access to telehealth does not abruptly end.”

“The use of telehealth services during this crisis has demonstrated the critical role technology can play in improving health equity,” said Rep. Sherrill. “No one should have to go without care when a video or phone conversation with a health care provider could mean quicker, safer medical attention.”

APTA President Sharon L. Dunn, PT, PhD, applauded the bill on behalf of the association, saying that “the use of telehealth during the pandemic has helped ensure patient access to physical therapist services, minimize potential exposure to the virus, and provided an option for therapy clinics and their patients during quarantine restrictions — and it’s made it all the more clear just how valuable telehealth is to patients who may need alternative access to therapy.”

“Passage of this bill would represent a major win for physical therapy and the patients they serve,” said David Scala, APTA senior specialist of congressional affairs. “We need to seize the momentum on telehealth and make it clear to lawmakers that maintaining it as an option for Medicare beneficiaries is the right thing to do.”

Get Involved

It’s time to make telehealth a permanent option for PTs and PTAs. APTA makes it easy to add your voice to the effort: PTs, PTAs, students, patients and others can send messages to lawmakers by way of the APTA Patient Action Center. Just follow the instructions for contacting members of Congress.

Telehealth monitoring program provides feeling of safety for COVID-19 patients

By News

When the COVID-19 pandemic reached the small, rural town of Kingstree, South Carolina, Sandra Epps watched her tight-knit community grapple with the devastating disease. Before long, several of her own friends had lost their lives to the virus.

“It was heartbreaking,” Epps said. “It just impacts you in a lot of ways.”

Epps decided to get tested for COVID-19 after realizing she had mild symptoms. She was tested through the Medical University of South Carolina and was contacted immediately about her positive result. Along with the information about her test result, Epps was given the option to be monitored remotely by nurses located at MUSC.

Remote patient monitoring is a virtual care program that allows patients to be monitored through telehealth, while they stay in the comfort of their own home. By logging on to her patient portal, MyChart, Epps could answer questions about her symptoms. Nurses would contact her by phone or email to check in, give advice, and provide reassurance. Epps said the monitoring program made her “feel safe.”

“I was reassured and I wasn’t as frightened,” Epps said.

The novel coronavirus pandemic, which has killed more than 7,800 people in South Carolina, led many healthcare systems to adopt remote patient-monitoring models in an effort to keep hospitals from being overwhelmed.

For patients, remote patient-monitoring allows nurses to monitor symptoms closely and react quickly if needed, according to Dr. Marty Player, Associate Professor of Family Medicine and Co-director of Primary Care, Telemedicine at MUSC.

“We’re keeping contact and accountability with our patients in a much more timely way,” Dr. Player said.

Knowing that a caregiver is accessible has eased patients’ anxiety, he added.

Many of the patients who have been monitored remotely have said the virtual program prevented them from visiting the Emergency Department or an Urgent Care, according to David Wheeler, telehealth patient and provider experience coordinator at the MUSC Center for Telehealth.

“They were able to get through any kind of crisis or spike (in their illness),” Wheeler said. We were able to shepherd them through that.”

VA Officials See ‘Digital Divide’ as Biggest Remaining Telehealth Obstacle

By News

After a year of moving IT heaven and earth to enable a huge jump in telehealth services for veterans during the coronavirus pandemic, officials from the Department of Veterans Affairs (VA) said March 23 that one of the biggest remaining obstacles to delivering telehealth is a lack of sufficient and/or affordable broadband service in areas where some veterans live.

VA’s success in ramping up telehealth services during the pandemic has been well documented, with daily service capacity rising ten-fold by mid-2020, to 35,000 appointments per day and the ability to hold 17,000 concurrent sessions. By February of this year, VA was averaging 45,000 telehealth visits per day, up from just 2,500 per day in March 2020.

With firm plans to keep moving forward with telehealth into the post-pandemic era, VA officials said at an event organized by AFCEA Bethesda that a lack of robust broadband infrastructure – along with affordability and service uptake issues among some veterans – represents a big hurdle to further progress.

“One of the biggest telehealth challenges is covering the digital divide in rural areas,” said Jack Galvin, Associate Deputy Assistant Secretary, OI&T Information Technology Operations and Services at VA.

Dr. Kevin Galpin, Executive Director, Telehealth Services, Office of Connected Care, at the Veterans Health Administration (VHA), agreed. “The digital divide is by far the number one issue that we are encountering and dealing with,” he said.

“We have a lot of veterans for whom it’s hard to get affordable internet … or they don’t subscribe” to the service, said Galpin, who cited a 2019 Federal Communications Commission (FCC) finding that 15 percent of veterans don’t have broadband service.

Galpin explained that veterans can be directed to the FCC’s Lifeline program to get subsidized broadband service, or that VA can provide veterans with 4G connected tablet devices in order to receive telehealth services. The agency, he said, has purchased more than 100,000 of the devices to distribute to veterans.

“It’s probably the biggest barrier – just making sure that everyone in this country is connected,” Galpin said. “It’s a crisis … for those that don’t have [broadband service], it’s a real big problem.” He added that VA is excited to work with the government and private sector firms “to get people to the right side of the divide.”

Locking in Pandemic Gains

Elsewhere during the March 23 event, VA officials explained they are looking to make permanent the agency’s pandemic-era gains in telehealth and other veterans services, and then press on with additional IT-driven service improvements going forward.

Galpin said that VA’s various telehealth programs logged 5.6 million “episodes of care” for veterans in 2020, and have “become an integral part of how we deliver services.”

“The vision of our office is to enhance the accessibility of healthcare to patients and caregivers … and bring care closer to the veteran,” he said. During the pandemic, he said, VA showed “how flexible the organization was in the complete pivot of the care delivery model …  Everything had to be scaled and pivoted … to see an organization do that in such a nimble fashion needs a spotlight shined on it.”

Galvin said the quick pivot in care models benefited from brushing past “the bureaucratic things that used to hold us back.” The conditions brought on by the pandemic, he said, “really brought to the forefront of what the art of the possible was … and shows what we can do with the right impetus.”

“The new functionality was delivered very rapidly … I think it’s here to stay,” Galvin said.

Dr. Ryan Vega, Chief Officer, Healthcare Innovation and Learning at VHA’s Office of Discovery, Education, and Affiliate Networks, credited the sharp ramp-up in VA telehealth programs during the pandemic as “the only way we were able to reach veterans for chronic care.”

In addition, he pointed to the agency’s work in improving customer-facing websites to deliver healthcare information to veterans. Those efforts, he said, “sometimes are below the surface, but they played out to be incredibly vital” to overall service delivery during the pandemic. “It was all of those pieces that came together,” he said.

Galpin said the quick move to telehealth services was greatly helped by planning that VA started in 2018 with the goal of delivering more care to veterans in their homes by 2021. When the pandemic hit, much of the service pivot “was accelerating what we were doing.”

“It was part scale, and part pivot,” he said, adding, “we had a lot of the platforms in place that we could move from.”

“You can’t wait for an emergency and then think you are going to do it well,” he said.

More rural access to telehealth is critical post-pandemic, advocates say

By News

Shaun Robinson
Boston University Statehouse Program
Published 4:40 a.m. ET Mar. 18, 2021″

BOSTON – Outer Cape Health Services runs three clinics in one of the state’s most rural coastal areas, but for much of the past year, many of their patients have sought care from home. Some are measuring their blood sugar levels on a clinic-provided monitor; others are phoning in for behavioral medicine.

The organization, which has locations in Provincetown, Wellfleet and Harwich Port, took a financial hit and furloughed staff last spring as the number of in-person visits fell, said Pat Nadle, Outer Cape Health Services CEO. Still, Nadle said, remote care is going to stick around as patients come back in. The technology may even help doctors serve them better.

Remote care may help doctors serve patients better

In rural Massachusetts communities from Nantucket to Berkshire County, local health care providers are playing a critical role in the state’s fight against COVID-19. Yet, many of these facilities, which already were operating on thin profit margins and with small staffs, have faced outsized challenges as patients canceled elective procedures and doctors took on additional responsibilities.

Now, as vaccines are rolling out statewide and a new, post-pandemic normal is in sight, advocates say rural health care centers need strong support from local residents and lawmakers. In addition, advocates say, expanding access to telehealth, which lets doctors reach patients safely in underserved areas, is critical.

“They’re not just providing quality health care, but they’re also an economic driver in the community,” Ann Marie Day, executive director of the New England Rural Health Association, said of programs such as Outer Cape Health Services. “They provide a lot of jobs and bring a lot of folks to the community to work, so it’s really important to be able to invest in those rural safety-net providers.”

Statewide, hospital profit margins fell about 4.5% by the end of June 2020, compared with the same time a year earlier, according to the most recent data from the Center for Health Information and Analysis. Less than half of hospitals were in the black, the center found, and the median total margin was -0.7%.

Community hospitals, which serve many of the state’s most vulnerable communities, were among the hardest hit, the data shows. They reported a roughly 7.5% drop in profit margins, and a median total margin of -4.8%. Without government support, the report states, facilities would have gone deeper into the red.

Hospitals in Massachusetts received about $1 billion in federal funding and about $160 million in state funding through the end of last June, according to the report.

President Joe Biden’s approved COVID-19 relief plan includes $8.5 billion of funding for rural hospitals and health care centers to cover expenses and lost revenue as a result of the pandemic. The plan also will provide $500 million for Department of Agriculture grants to rural providers.

“Support from the state and federal government has helped our community hospitals survive this crisis,” Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association, said in a statement. “We remain in close contact with our elected officials to ensure these providers have the resources they need moving forward.”

Providers also have benefited from a state law signed in January requiring insurance companies to provide equal coverage for telehealth and in-person visits, or what is known as coverage parity.

Telehealth lets doctors safely reach patients in underserved areas

Andrew Solomon, senior program manager for Northeast Telehealth Resource Center, said while remote care has helped rural hospitals reach patients for decades, the need for social distancing, as well as legislation like the commonwealth’s parity law, have made the technology more ubiquitous and accessible.

For patients who have a disability or live in areas with limited transportation options, Solomon said, telehealth is a vital tool that enables access to care. Patients who live in small communities may not want to be seen receiving treatment and so prefer the privacy of telehealth, he said, and in some cases, a virtual emergency room visit can provide more timely care than an in-person visit would.

“Providers who hadn’t adopted telehealth before are seeing benefits like reduced no-shows, and those kinds of things are big drivers for providers,” Solomon said. As demand increases and “consumers get more familiar with the potential benefits,” he added, “there will continue to be big drivers there.”

Day, of the New England Rural Health Association, said one challenge for rural telehealth care continues to be limited broadband internet and cellphone connectivity. This is why it’s important that insurance covers telephonic visits, she said, since all that some households may have is a landline.

In 2016, the state identified more than 40 towns in western and north central Massachusetts lacking residential access to broadband. Towns can apply for state grants to build municipally owned networks.

What is telehealth?

“Telehealth is a very broad term,” Solomon said. “There’s a lot of applications and use cases within that, that range from the on-demand live video to remote patient monitoring to provider education opportunities.”

Solomon said telemedicine also allows for joint consultations between primary care providers and specialists, which can help save patients’ time. For instance, he said, a primary care doctor could take a picture on an iPad and send it through a secure platform to a dermatologist; the latter could then decide whether the patient could be treated where they were or whether they required more advanced care.

“Specialists don’t drive out to the Outer Cape much,” said Nadle, of Outer Cape Health Services. “To be able to ‘Zoom’ into a specialist in the treatment room, while you’re in there with your primary care provider, is certainly an option right now to help coordinate care in a much different way.”

Day said rural medical providers also are important vehicles for getting COVID-19 vaccines out to isolated and vulnerable people in their communities. Outer Cape Health Services is distributing about 600 to 800 shots per week across each of its clinics, Nadle said.

In addition to the vaccine rollout, Nadle said, the organization is expanding support for victims of substance abuse who may have been especially struggling with the stressors of the pandemic. Behavioral health care has worked well as a remote service, she said.

At Athol Hospital in northern Worcester County, one takeaway from the pandemic has been the importance of staff collaboration, said Dawn Casavant, vice president of external affairs for the hospital’s parent organization, Heywood Healthcare. Senior leadership and managers have started holding daily meetings to share updates from across the hospital’s departments, she said.

Athol Hospital is a critical-access hospital, a federal designation given to some rural hospitals in remote areas.

“The intersection of all of the primary areas that allow a hospital to function was exaggerated by 1,000% when you’re in a pandemic,” Casavant said. “It’s proven to be really worthy and beneficial for the system to have that opportunity every single morning to start the day on the same page.”

Amazon Announces Nationwide Telehealth Platform, Open to Other Businesses

By News

The retail giant announced today that its telehealth platform, previously available only to employees and their families in Washington, would roll out nationwide this summer and be offered to other businesses.

By Eric Wicklund

– Amazon has announced the nationwide launch of its telehealth platform, with plans to expand the service from its own employees to other companies.

The Washington-based retail giant announced today that its Amazon Care service, until now limited to employees and their families in its home state, is now available for other Washington companies, and that the platform will be expanded to Amazon employees and other companies throughout the country beginning this summer.

Finally, the company announced that it would offer in-person care to Washington DC, Baltimore and other cities in the near future.

The long-rumored announcement puts Amazon securely in the middle of the retail telehealth sandbox, with a virtual care platform that could appeal to a wide range of businesses. It is expected to compete in a crowded connected health space with vendors like American Well and Teladoc, as well as with payers and health systems offering their own branded programs.

“By supplying Amazon Care as a workplace benefit, employers are investing in the health and well-being of arguably their most important asset: their employees,” the company said in a press release. “Amazon Care enables employers to provide access to high quality medical care within 60 seconds for employees, including options for care around the clock through messaging or video. Amazon Care gives instant access to a range of urgent and primary care services, including COVID-19 and flu testing, vaccinations, treatment of illnesses and injuries, preventive care, sexual health, prescription requests, refills, and delivery, and much more.”

Amazon unveiled the platform roughly 18 months ago, offering virtual care through an mHealth app and on-demand house calls for employees and their families in Washington. In doing so, the company helped to elevate the direct-to-consumer telehealth market, where retail companies like Google, Microsoft and Apple were beginning to compete with Walmart, Walgreens, Rite Aid, CVS and health systems to capture the attention of consumers who didn’t have primary care providers or who were looking for more convenient ways to access on-demand services.

The coronavirus pandemic has only added to the urgency, pushing more services online and away from hospitals, doctors’ offices and other healthcare sites.

“Amazon Care addresses a wide spectrum of patient needs through its primary care and urgent care offerings,” the company said in its press release. “Patients can access preventive care such as annual vaccinations, health screenings, and lifestyle advice. The service also supports patients’ wellness needs, including nutrition, pre-pregnancy planning, sexual health, help to quit smoking, and more. For immediate needs, patients can use Amazon Care to assess and treat illnesses and injuries on demand.”

The announcement could spur a new round of retail healthcare offerings or telehealth partnerships, such as the recently announced merger of Doctor On Demand and Grand Rounds.

“This is a very exciting chess move from Amazon Care,” Taqee Khaled, head of strategy and a healthcare consultant for the consulting firm Nerdery, said in an e-mail to mHealthIntelligence. “A lot of folks will look at this on the outside and not realize how extensively Amazon has been preparing for this moment by obsessively striving to serve their own people exquisitely well. In their iterative process, where fast failure is not just expected but encouraged, they have tried and failed as much – or more – than they’ve succeeded. Along the way, they probably learned a lot and tabled several things for future use toward external competitive advantage.”

“That they’re ready to go national with this is a fearsome prospect for other platforms – and commences what will likely be the digital healthcare equivalent of a Hundred Years War,” he added. “To date, many startups and maturing companies play in this space. … But Amazon perfecting the last mile, pharmaceutical management, virtual care, and – yes, expect it – brick and mortar, may truly mean ‘the end (of traditional health systems) is nigh.”

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