COVID-19 Telehealth Metrics Could Let Applicants Fall Through Cracks: Experts

The application filing window for the second round of the FCC’s COVID-19 telehealth program is scheduled to open at the end of the month (see 2104150036), but policy experts warn the evaluation metrics could cause healthcare providers and facilities in need to lose out on hundreds of thousands of dollars in funding.

One metric that can give an applicant the most points is being located in an area "hardest hit" by COVID-19 (see 2103300063). The FCC defined that as an area “designated as either a ‘sustained hotspot,’ or a ‘hotspot,’ on the COVID-19 Community Profile Report, Area of Concern Continuum by County dataset provided by the U.S. Department of Health and Human Services.”

The FCC “has a really tricky road ahead in trying to get this right,” said Kyle Zebley, American Telemedicine Association director-policy: “People could always quibble with whether or not they made the right judgment, and that means by nature there are going to be people that are going to lose out that will feel that they lost out unjustifiably.”

"We retained the 'hardest hit' evaluation metric to ensure that COVID-19 telehealth program funding was directed to areas impacted by COVID-19," said an FCC spokesperson. "The hardest hit metric is one of nine different evaluation metrics -- six of the other evaluation metrics prioritize communities with at-risk populations."

Communities across the country are experiencing spikes in COVID-19 infection rates at varying times, and there could be other ways to measure the hardest-hit areas, like the number of deaths or individuals at risk of infection, said epidemiologist Jill Jim, Navajo Nation Department of Health executive director. "Nothing has changed between round one and two, other than the money might not have been sufficient to address [an applicant’s] entire need,” she said.

The impact of COVID-19 “hasn’t plateaued for a long time,” said Jim, who was on President Joe Biden’s COVID-19 advisory board during the presidential transition. “Cities might have gone up or down, but there are probably areas where their numbers are still high” even with new vaccine efforts.

There’s a “real risk” that applicants could fall through the cracks, Zebley said, but the commission tailored its evaluation metrics to help areas that need it most after transparency concerns were raised during round one (see 2012230078). Round one applicants who were unfunded can receive 15 points just for applying during round two. The goal was to ensure those providers are given priority over those that previously received funding. But those applicants may be in areas that are no longer considered a hot spot, so the FCC “has its work cut out for it” as it decides who receives funding, Zebley said.

The “hardest hit” factor is subjective, said Josh Seidemann, NTCA vice president-policy. “There can be many ways in which areas can be hardest hit.” The commission acknowledged as much in its final rules for round two but said it found it "appropriate" to prioritize funding to providers in areas that are “most-impacted" by the pandemic. But, Seidemann said, one area could have high rates of infections, while another could have a certain proportion of the population with higher rates of infection than others.

Healthcare providers are still digesting the rules for round two and rushing to get ready to apply when the filing window opens April 29, Zebley said. “There’s a huge hunger for this funding,” he said, but there’s a “great realization that there are far more potential applicants than there will be money to go around."