Texas' Broadband Boom: An Influx of Funds Could Turbocharge Telehealth Access
By Emma Freer Texas Medicine October 2023


Odessa internist Rama Chemitiganti, MD, rattles off several high-tech initiatives underway at the Texas Tech University Health Sciences Center (TTUHSC) School of Medicine, where he is regional chair of the department of internal medicine.

TTUHSC not only is a long-time advancer of telehealth but also is using artificial intelligence (AI) to improve interoperability between electronic health records (EHRs), to transcribe notes during patient visits, and to develop a care management app for patients with chronic diseases. (See “Medicine Meets AI,” page 15.) He also cites the increasing use of remote patient-monitoring devices.

Each of these initiatives is a boon for telehealth practitioners in rural and underserved areas where patients often lack the transportation necessary to access in-person health care, which may be as far as 200 miles away.

But Dr. Chemitiganti laments that such progress is hampered by a more fundamental problem: the lack of reliable broadband access, which often is most acute in medically underserved areas.

A study published in June by Mayo Clinic Proceedings: Digital Health found “[m]ost health care-underserved communities in the United States are located in digital deserts with low high-speed internet access.” These digital deserts, in turn, “might exacerbate health care disparities in these vulnerable communities.”

Connectivity varies across Texas counties, dipping as low as 21% in Kenedy, which qualifies both as a health professional shortage area and as a medically underserved area, according to availability estimates from Connected Nation Texas and to the Texas Department of State Health Services Health Professional Shortage Area Dashboard.

“The technology’s evolving, but that technology is meaningless if [patients] don’t have broadband,” Dr. Chemitiganti told Texas Medicine.

This broadband block may soon be cleared. The federal government recently granted Texas $3.3 billion – the largest award of any U.S. state – to deploy and upgrade broadband networks, critical to ensuring access to telehealth care.

The funding stems from the Infrastructure Investment and Jobs Act, a $1 trillion bipartisan law that President Joe Biden signed in November. Its provisions included the creation of the Broadband Equity, Access, and Deployment (BEAD) Program, which aims to expand affordable, high-speed internet service.

The federal grant follows the Texas Medical Association’s ongoing advocacy in this area, which has undergirded years of progress at the state level. In May, TMA also joined the Texas Broadband Development Office’s (TBDO’s) Health Task Force, which advises the office on BEAD program planning, including troubleshooting barriers to broadband expansion.

Thomas Kim, MD, a member of TMA’s Council on Science and Public Health and of its Committee on Behavioral Health, is “super excited” about the award, which he says will support countless industries and demographics. The Austin psychiatrist also serves on the Texas Governor’s Broadband Development Council.

“This investment is so much bigger than just improving health care, which it will by connecting more doctors to more patients in more places,” he said.

A Texas-sized problem

Texas’ grant is proportional to its need and indicative of the work required to meet it.

Roughly 7 million Texans across 2.8 million households lack broadband access, according to TBDO.

“While this funding exceeds the amounts allocated to any other state or territory, it also means Texas has the most unserved addresses in need of reliable connectivity, and more work is required to close the digital divide,” TBDO wrote in a June 29 announcement.

Andrea Pacheco, outreach coordinator for TBDO, said the grant will lessen, but likely not close, this divide.

“It’s estimated that that $3.3 billion will move us a long way toward universal connection,” she told attendees of TMA’s Border Health Caucus in Harlingen on Aug. 18.

The scale of Texas’ broadband need isn’t the only challenge. Dr. Kim says the state also must map its broadband deserts, create a disbursement process, and ensure any resulting broadband service is affordable for Texans in need.

“Access to a particular resource like broadband internet is not a guarantee that there will be meaningful utilization,” he said.

Dr. Chemitiganti points out other barriers, such as making sure that improved broadband access translates to tangible gains in health care access and educational attainment in underserved areas.

“Just laying the fiber-optic cable or creating connectivity is one of the goals,” he said. “But the metric by which we measure success should not be the length of fiber-optic cable laid.”

With the grant awarded, TBDO now must submit a proposal to the National Telecommunications and Information Administration detailing its BEAD-funded programs. The state agency says it will solicit public feedback in the drafting of this plan, and Texas Comptroller Glenn Hegar expects TBDO will accept applications for BEAD funding starting next year, according to a June 29 news release.

There also are concerns about the grant rules. Small internet service providers in rural areas worry such rules are prohibitive and counterproductive as they require applicants to secure upfront funding from a major bank, which often is out of their reach, as The Texas Tribune recently reported.

Dr. Kim also notes broadband expansion must be supported by industry-specific changes at the state level.

For instance, he cites pandemic-era flexibilities such as telehealth payment parity, which incentivizes physicians to continue offering virtual services by paying for them at the same rate as in-person visits.

“To continue to treat telehealth care as something different than conventional health care is a mistake,” he said. “So long as [physicians] meet the regulatory expectations, it should not matter how care is delivered.”

A multipronged approach

The federal grant arrives in the midst of significant state investments in broadband expansion heralded by TMA.

At the state level, the 2023 Texas Legislature’s passage of House Bill 9 by Rep. Trent Ashby (R-Lufkin) proposes a constitutional amendment – due to go before voters in November – that would create a $1.5 billion Texas Broadband Infrastructure Fund, supplementing the $3.3 billion federal grant.

During the 2021 session, the Texas Legislature also passed two pieces of TMA-backed legislation:

  • House Bill 4 by Rep. Four Price (R-Amarillo), which made permanent pandemic-induced allowances for expanded telehealth payment in Medicaid and the Children’s Health Insurance Program, if the state determines those services are clinically sound and cost-effective; and
  • House Bill 5, also by Representative Ashby, which established the TBDO.

Michelle Romero, TMA’s associate vice president of public affairs, says these developments work in tandem to expand access to high-quality, physician-led care. Especially in the rural and underserved communities hit hardest by Texas’ physician workforce shortage, they help ease the use of telemedicine and remote monitoring services.

Dr. Chemitiganti is hopeful that the influx of federal and state funding will catalyze a broadband boom as well as meaningful advances in the many industries – including health care – that are contingent upon such access.

“This is a major step in that direction, depending on how we prioritize spending this money,” he said.

Last Updated On

October 18, 2023

Originally Published On

September 29, 2023

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Telemedicine | Texas legislation

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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