BOSTON — COVID-19 forced businesses in nearly every industry to shift overnight to a virtual model — including the health care system.
Medical consultations, physicals and check-ins were all brought online and now, almost two years later, it seems more people prefer it that way. Telehealth services are now being used at 38 times the level they were before the pandemic began.
But despite the positive feedback from patients, lawmakers and doctors alike are asking the same question: Can you conduct a proper virtual consultation — whether physical or behavioral — when the patient doesn’t have the proper equipment to log onto their appointment?
“Prior to the pandemic, we focused on barriers such as lack of transportation or inability to get time off work as major barriers to getting care,” said Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School. “The lack of internet access is a new barrier that many patients face in accessing care.”
Telehealth services proved useful when treating minority and underserved populations, specifically Black and Latinx communities, who didn’t enjoy close proximity to clinics and doctors. Those demographics also proved significantly more susceptible to contracting COVID-19, further pushing ethnic minorities to virtual consultations.
“The digital divide disparately impacts poor communities and communities of color,” Michael Curry, CEO of the Massachusetts League of Community Health Centers, said in a statement.
According to Boston25, about 1,200 families in Boston alone lacked internet access as of August 2020, with many more reporting they did not have computers at home. In addition, MassINC reported that 40% to 50% of homes that do have internet access lack broadband service. Without fundamentals like computers and proper internet access, neither the doctor nor the patient can make an appointment.
As the digital divide becomes more apparent, state lawmakers are looking for ways to support lower-income residents with proposals to expand broadband internet.
“Researchers have found broadband internet access to be a social determination of health,” said state Rep. Danillo Sena, D-Acton. “And then it has become even more obvious or more important with the pandemic and with COVID.”
Sena is a big proponent of petitioning for a formal investigation into the relationship between broadband internet and public health care services in Massachusetts. Sena said the bill’s first steps would include funding for public housing, through which tenants would be guaranteed broadband access throughout the building.
“Access to broadband or access to internet and Wi-Fi became more of a right and not a privilege,” Sena said. “That’s why we’ve filed this bill, because it’s so important that people have access to Wi-Fi.”
On a broader scale, the states Senate passed the Patients First Act in 2020 as a means to ensure all state residents get proper health care access and services. Since then, Senate President Karen Spilka, D-Ashland, has made it a priority to ensure all Massachusetts residents have equitable telehealth access, including broadband internet.
“Part of what (Gov. Charlie Baker and the Senate) talk about is contacting and being in touch with communities across the state that either have strong broadband access or lack it,” Spilka said. “And the state, I think as a whole, has made a conscious effort to try to help communities in different areas of the state to increase their access and have it on a more reliable basis.”
According to Spilka, the Senate has bolstered funding from the federal American Rescue Plan Act via various bills and proposals to expand internet access to lower socioeconomic demographics. ARPA funding has also been in the works to provide financial assistance to residents who cannot afford to pay internet fees.
“We need to just redouble our efforts to make sure that every ZIP code of Massachusetts has strong reliable access to broadband and the internet, and is able to connect,” Spilka said.
Likewise, private entities, including the Massachusetts Health and Hospital Association, are also working toward overcoming the digital obstacle by seeking partnerships with state officials.
“Telehealth is a permanent part of our health care system’s future, but it will only reach its full potential once it is accessible to everyone throughout the commonwealth,” said Akriti Bhambi, MHA’s director of health equity. “MHA and our members are working in partnership with our elected leaders to ensure that all community members — no matter their location or means — can utilize virtual services to the greatest extent possible.”
As the private and the public spheres begin to work together to promote equitable telehealth services, the extent of how these partnerships can expand broadband access comes into question.
“There are some pretty archaic Medicare regulations that restrict … where telehealth services can be offered to beneficiaries in a post-pandemic landscape that I think many hospitals are looking to see addressed by the federal government before the end of the pandemic,” said Mara McDermott, a vice president at McDermott+Consulting, a Washington-based business management consultant.
Stephen Bernstein, a partner with international law firm McDermott Will & Emery, spoke to that same note, saying the government is susceptible to falling back to tougher pre-pandemic health care and infrastructure policies rather than expanding upon new needs.
“The fear is that as the federal government turns that relaxation off — they haven’t yet — and various states start to do the same, that there’s an automatic go-back-in-time world where the old rules automatically apply,” he said. “And I think that is what’s happening as a result. That’s crazy. We’ve made progress. Why would you want to do that?”
With a new governor taking office in 2023, lawmakers say the next steps for Massachusetts’ broadband and telehealth expansion remain unknown. But there is optimism.
“I think this is something (in which) we’ve made strides, (but) we need to keep working on it,” Spilka said. “And I would imagine whoever is governor will continue to pick up the mantle on this because it’s so critically important to the health of our residents, to the economic vitality, to our commonwealth, and to the education of our residents as well.”