Photo by Markus Spiske on Unsplash
In a 3-2 vote December 14th, the FCC decided to overturn its rules around net neutrality. But, what does this deregulation mean for virtual care?
While no one can truly know the future, some very real concerns have been raised about the impact of internet deregulation on virtual care. As an industry, healthcare relies on the internet to support numerous technologies and services. Particularly when it comes to virtual care, maintaining a basic level of access is critical.
The intent of net neutrality regulations were to help ensure a level playing field for internet users (we call them patients) and businesses and other organizations by banning paid prioritization. That means internet service providers aren’t able to modulate speeds based on the destination. FCC Chair Ajit Pai has stated that eliminating this ban will enable the ability to prioritize healthcare services, though others responded that the regulations allowed for internet “fast lanes” for healthcare and other critical services.
Many thought leaders, however, believe that the repeal of net neutrality has a high likelihood of diminishing access to online care delivery and actively harming small practices. Hematology and oncology publication Healio noted specifically that individual providers and those in rural areas are vulnerable in a tiered pricing system. A pre-overturn piece in Modern Healthcare also noted that, “Prohibitively high Internet costs could exacerbate health disparities between high- and low-income people and between people in urban and rural areas.”
I’m less concerned about the impact of deregulation on the internet service provider (ISP) industry than I am about the downstream effects. Healthcare has traditionally been local, with the patient-provider relationship at the heart of care delivery. The regulatory environment already poses challenges to health systems and providers, and healthcare systems throughout the U.S. are facing well-documented financial challenges. This deregulation adds a further layer of complexity and potentially cost for providers and health systems already facing unprecedented challenges.
Eliminating the ban on paid prioritization and moving to a tiered pricing system has the potential to unleash a “demolition derby” effect. Smaller organizations like rural providers and critical access hospitals with fewer resources may find themselves crushed and pushed aside. Non-profit health systems which are on increasingly tight operating budgets and are facing a negative outlook for 2018 according to Moody’s, may need to route limited resources away from clinical services and into purchasing connection speeds. Industry monster trucks could end up with free reign to roll over the competition.
Managing Risk in the Demolition Derby
Where telemedicine stands to lose the most is in the modalities that truly require bandwidth like video-based care delivery. And this is important because, as much as I may have railed against the over-reliance on video in the past, it is an important modality for certain patients and use cases. It’s vital that video-based care be able to flourish, along with other bandwidth intensive telehealth needs such as diagnostic imaging.
While a knee-jerk reaction is never a good idea, as citizens and members of the digital health community, it’s important that we monitor how this repeal impacts patient access to care and the ability for all providers and healthcare organizations to deliver care online. Chairman Pai believes that eliminating net neutrality restrictions will improve access to online care for patients. While I’m not fully convinced, I am adopting a hopeful attitude. Organizations like the American Telemedicine Association are closely watching and ready to mobilize if patient access is threatened.
In the interim, providers and healthcare organizations can mitigate their exposure posed by the repeal of net neutrality regulations by leveraging technologies that require lower bandwidth to provide online care. Store-and-forward technology, like our online adaptive interview, provides access to care that doesn’t require the same bandwidth as face-to-face video visits, while maintaining a high standard of care. In fact, it was the use of mobile phones in rural Africa, over super thin bandwidth cell networks, that inspired me to start Zipnosis. One of my maxims is that constraints are where innovation occurs. With new regulation comes new constraints and also new innovations to maximize our potential for better access to healthcare.
What the Net Neutrality Repeal Won’t Do
We don’t have a clear picture of precisely what this deregulation will do, but the one thing it won’t do is slow the adoption of online care. Offering a virtual care solution, tiered bandwidth or no, is going to be critical to the success of health systems and providers going forward. As such, we need to do our best to manage risk, support care delivery online, and work together as an industry to help ensure that providers and patients are in the driver’s seat.