AUSTIN, Texas — Texas Republicans don’t usually look to Lyndon Johnson for inspiration.
But the need for improved broadband services in rural areas — to spread telemedicine, viewed as the next frontier of medicine — has caused some to look to the former president’s efforts to connect those same areas to the electrical grid.
“I’m a conservative Republican and believe private enterprise should do that,” said Texas Agriculture Commissioner Sid Miller. “But we kinda got a unique problem in rural Texas.
“I can compare it to when electricity first became available and we had [Johnson’s] Rural Electrification Program,” said Miller, an avid supporter of President Donald Trump whose reelection was endorsed by far-right groups. “There’s not enough profit. As a matter of fact, there’s probably not any profit to bring that out to remote areas for the private sector.”
Rural areas have long suffered from the lack of broadband connectivity. But the demand for telemedicine, which can virtually bring doctors and nurses to poor, rural areas with few clinicians, is renewing state and federal efforts to improve internet infrastructure.
Last year, Texas lawmakers passed bills that made telemedicine legal and improved the reimbursement process to help rural counties contend with provider shortages and hospital closures. When they next meet in 2019, the legislature will take up bills to help rural areas get connected to high-speed Internet services, said Blake Hutson, associate state director for advocacy at AARP Texas.
“We definitely see broadband as big barrier,” said Hutson. “A lot of cutting edge concepts in telemedicine are not available to people in rural areas.”
The chief obstacle for rural providers is the cost of laying lines.
Texas lawmakers are filing bills that broaden the use of telemedicine to provide mental health counseling and deliver forensic care to sexual assault survivors. Yet as Texas and other states open the doors to telemedicine, providers can’t afford the high-speed connections they need to install the remote service.
More than a quarter of Texas’s rural population lacks fixed broadband access, according to an August report from the Texas Health Improvement Network. Nationally, more than 30 percent of rural people lack access, according to the Federal Communications Commission.
Earlier this year the FCC boosted a rural broadband grant fund to $581 million from $400 million — the first funding increase since Congress created the program nearly 20 years ago. The FCC also approved a $100 million pilot to fund projects that connect low-income Americans to telehealth services.
That’s still a fraction of what the FCC makes available to school and libraries under a separate $4 billion fund.
Many say that federal agencies and Congress aren’t doing nearly enough to help rural areas connect to high speed Internet for telemedicine.
“Botswana has a plan for universal broadband,” said Susan Dentzer, CEO of the Network for Excellence in Health Innovation. “It’s just unspeakable that we don’t have that and it’s not even on the agenda.”
Lack of coordination in building out broadband for health care is one of the biggest problems in Texas, said Republican state Sen. Charles Perry, whose district includes 51 counties over 48,000 square miles.
Last year the state made $25 million available to help school districts tap into federal funds to pay for installing high-speed internet in classrooms. Sometimes local entities would apply to lay lines where fiber already existed, while passing over areas that needed connections for health care.
“[W]hen you put government money to a problem and you don’t give some direction to vendors engaged in applying for those dollars, you don’t get the outcome” you want, Perry said.
Health care providers in Texas have been on their own when it comes to getting federal cash for laying broadband cables.
Take Culberson Hospital in the town of Van Horn, which sits on a busy stretch of highway in remote West Texas yet has only one doctor. To help handle a regular influx of car crash victims, Culberson contracted with a company that connects the trauma center’s staff to a nurse and physician in South Dakota with the push of a red button.
The hospital worked with the state health department to get around a regulation requiring a physician be physically present at the trauma center within 30 minutes. But the state did nothing to help the hospital lay the fiber optic cables needed to connect the facility to a broadband connection fast enough to make remote surgery workable.
In the end the hospital applied independently for a federal grant that covered the costs of laying the lines. The group that runs the Van Horn hospital has connected six additional hospitals and received grants totaling more than $200,000 over three years.
The growth of telemedicine so far, especially in rural areas, “is a direct result of the proactivity of hospital administrators,” said Don McBeath, director of government relations for the Texas Organization of Rural and Community Hospitals.
There hasn’t been enough coordination between state facilities to take advantage of existing lines and technology, he said.
“The state needs to get a handle on this issue,” said McBeath. “Nobody knows who is doing telemedicine and what kind of telemedicine they are doing.”
The lack of state coordination disproportionately affects smaller clinics that lack the resources to apply for federal grants.
Methodist Healthcare Ministries places nurses in more than 80 sites, including churches, around 74 South Texas counties, to offer health screenings and outreach. But when the organization tried to broaden the nurses’ reach with telemedicine, it faced challenges in getting broadband access directly to the church. Sometimes it resorted to installing a satellite on a church roof to get a signal.
Ideally, said Pete Otholt, senior IT manager at Methodist, the group would like to use telehealth to make sure patients with chronic conditions such as diabetes, obesity or behavioral health issues receive frequent check-ups. But in the areas where his organization works, lack of connectivity is still a major obstacle.
“One of the things that is so important is having contact with patients,” said Otholt. “If they don’t have access to that, they are missing out on where health care is headed.”