Fastest and slowest rural broadband? MN not on either list

Good news or bad news? I’m not sure but SatelliteInternet recently posted the fastest and slowest broadband connections in rural America and Minnesota doesn’t make either list.

This site looks a lot like a commercial so I take much of what it says with a grain of salt but there are a number of provider options, including speeds and pridces in detail, which is nice for comparison to what you’re being offered in your community by these and other providers. They even outline the pros and cons of different services.

And they outline the issue…

According to the FCC’s 2020 Broadband Deployment Report, 22.3% of rural Americans don’t have access to internet download speeds of at least 25 Mbps (which is the recommended speed for working from home and online schooling).4,5 And the numbers are even worse on Tribal lands, where 32.1% of Americans don’t have access to internet speeds of 25 Mbps.5

Yet in metropolitan areas, only 1.5% of Americans lack access to these same speeds.5 Rural America’s lackluster internet speeds contribute to the homework gap and a lower percentage of college graduates when compared to Americans living in metropolitan areas.

They outline their methodology, which I think it interesting as we look at statewide speed testing in Minnesota…

Our data comes from speed tests taken on HighSpeedInternet.com. We examined results from more than one million US speed tests to find the fastest and slowest average rural internet speeds.

We defined a “rural” city as a community with a population of less than 10,000 people that is geographically removed from an urban city, which we qualified as meaning it’s at least an hour drive away from the nearest major city. We also filtered out locations with fewer than 50 speed test results to ensure accurate representation of the city’s average speed. In all, we ranked and researched nearly 600 rural cities in the US.

MN Health Care Provider COVID Survey: 85% would continue telehealth after COVID

Thanks to Teri Fritsma at Office of Rural Health & Primary Care for sharing their MN Health Care Provider COVID Survey. I’ve pulled out the stats that I thought seemed most broadband related. You can see that broadband has made telehealth easier in ways and COVID has accelerated adoption.

About the survey…

With the onset of the COVID-19 pandemic, MDH designed a brief survey to learn more about the changes Minnesota’s health care providers are facing at work as they respond to the pandemic. The COVID Health Provider survey focuses on a handful of COVID-specific topics, including providers’ concerns, time spent working, use of telemedicine, and related topics.

Some highlights…

▪ Approximately 15 percent of providers reported that their primary work location was some sort of remote site (such as their home), where they consulted with patients via telemedicine. However, this varied greatly by profession, with mental health professionals far more likely than others to be working in a remote setting away from patients or clients. An estimated 57 percent of licensed professional counselors (including LPCs and LPCCs); 54 percent of social workers; and 58 percent of psychologists reported that they were working remotely.

▪ More than half of all providers reported that at least some of the care they provided was remote—either via telephone, email, or dedicated telemedicine equipment (or all three). Again, this varied greatly by profession, with mental health providers most likely to be providing care via telemedicine or telephone.

▪ More than 85 percent of all respondents who were using telemedicine said they thought they would continue to provide at least some care via telemedicine after the pandemic ended.

▪ Nearly two-thirds of all respondents reported that their work had changed in some way because of COVID-19—for example, taking on new responsibilities at work, backfilling for other employees, and/or managing patients’ and clients’ COVID-19-related concerns. ▪ An estimated 23 percent reported that their worksite had been “totally prepared” to respond to the pandemic.

licensed marriage and family therapists renew their licenses in the fall and therefore would not have had the opportunity to take the survey

Comments on telemedicine…

  • “Telemedicine can be very challenging for patients who need an interpreter.”
  • “Should be allowed going forward. It’s very helpful for elderly patients who have a difficult time getting to appointments.”
  • “I work in mental health and I think it works well. We have fewer no-shows, and clients generally like it. A lot of people are uncomfortable coming in to the office even without a pandemic.”
  • “It’s okay for follow-up or non-acute care, but it doesn’t work for evaluating new, acute problems.”
  • “It’s been a great tool for some patients, but some (non-tech savvy) don’t have the ability to use it.”
  • “Exacerbates existing inequities in health care.”
  • “Telemedicine works well for me for people who struggle with transportation issues in rural areas.”
  • “It works in the sense that I can still provide much-needed client care. But it doesn’t work in the sense that there’s inequality in clients being to access telemedicine.”
  • “We need to do more of it. It improves patients’ care and our professional lives.”
  • “Telemedicine has been integral in providing services to vulnerable and oppressed populations that face transportation issues, scheduling concerns, unforgiving work schedules, family demands, and poor organization due to a variety of factors. It behooves us as social workers to fight for this service to remain a widely-available platform for services that have typically been gatekept for those with flexible business hours, reliable transportation, and available childcare.”
  • “I have found telemedicine a great way to provide care especially for established patients with whom I am familiar. It is a bit more difficult for complex medical issues and for multiple concerns but I think my patients really appreciate the option. There are some things that we still need to see patients for.” “The CMS rules going forward are unclear.” “Works great.”

 

NDIA looks at worst connected mid-large cities 2019 – includes some Minnesota cities

National Digital Inclusion Alliance reports on the worst served medium and larger cities. Some Minnesota cities are listed – but none are in the top 100 list. St Cloud is close at 102 but the list is long. Maple Grove makes the list but it’s ranking is in the 600s.

So I share this information more to let folks know what’s out there and because it’s nice to have specific data on cities. Here’s the background from the NDIA…

According to the latest data from the U.S. Census, at least 30% of households in 185 large and medium-size U.S. cities still lack a wireline broadband connection in 2019.

These are NDIA’s Worst Connected Cities of 2019.

Released by the U.S. Census Bureau in September 2020, the 2019 American Community Survey (ACS) One-Year Estimates includes household Internet access data for a total of 625 U.S. cities or Census designated places with populations of 65,000 or more.

NDIA has ranked all 625 of these communities by two categories:

  • the percentage of households without Wireline broadband subscriptions, defined by the ACS as “Broadband such as cable, fiber optic or DSL,” and

  • the percentage of each community’s households that lacked broadband Internet subscriptions of any type, including mobile data plans.

And here are details on MN cities…

Survey of Household Economics and Decisionmaking: Finances and COVID

Since 2013, the Federal Reserve Board has conducted the Survey of Household Economics and Decisionmaking (SHED), which measures the economic well-being of U.S. households and identifies potential risks to their finances. Recognizing the unprecedented financial disruptions caused by the COVID-19 pandemic, the Federal Reserve conducted a supplemental survey in April and July 2020 to monitor changes in the financial well-being of Americans.

The survey is conducting entirely online. So folks are the very far end of the digital divide are likely not included. It would interesting to know the impact of online only. It would also be interested in know the impact of having sufficient broadband among people who have gone back to work, hope to go back and those who aren’t likely to go back to the same job.

Broadband prices in the US decreased from 2015 to 2020

The 2020 Broadband Pricing Index reports…

Using Federal Communications Commission and other public data sources, this report assesses recent trends in residential fixed broadband pricing between 2015 and 2020 in the United States. The key findings:

  • The most popular tier of broadband service in 2015 (BPI-Consumer Choice) is now priced 20.2% lower and offers 15.7% faster speeds in 2020 on an average-subscriber-weighted basis.
  • The highest speed offerings in 2015 (BPI-Speed) are now priced 37.7% lower and offer 27.7% faster speeds in 2020 on an averaged subscriber-weighted basis.
  • Further, these price reductions run counter to inflation, which has increased consumer costs for overall goods and services by 9.3% over the same five-year period analyzed in this report. When inflation is considered, the real price of the most popular tier of broadband service has dropped by 28.1% since 2015; and the real price of the highest speed broadband service has dropped by 43.9%.
  • This combination of declining prices and rising speeds delivers even greater value to consumers—as shown by a declining cost per megabit of connection speed (Mbps) of 37.9% for the most popular service and 56.1% for the highest speed service.

This data shows that broadband is becoming more affordable—thereby reducing, but certainly not eliminating, an obstacle to adoption. For instance, we know that 30% of K-12 students do not have access to high-speed internet and/or the devices needed to learn from home. More work, understanding, and concrete data is needed around the vital issue of affordability and this report seeks to contribute to that discourse.

Does broadband policy matter? Turns out it does.

Last month, Telecommunications Policy posted a study from Brian Whitacre and Roberto Gallardo on the impact of state policies on broadband availability. The news is good for states and local governments who promote better broadband. And especially because Roberto will be one of our keynotes at the MN Fall Broadband conference I wanted to share the results.

Here’s the abstract…

We use a county-level panel dataset from 2012 to 2018 to assess the impacts of various state policies on total and rural broadband availability in the United States. The primary dependent variable is the percentage of residents with access to 25 Megabits per second (MBPS) download and 3 MBPS upload speeds via a fixed connection, with alternative specifications considering other aspects of availability such as technology type and competition. We control for the main determinants of Internet availability such as income, education, age, and population density. Our policy variables come from the newly released State Broadband Policy Explorer from the Pew Charitable Trusts and individual contacts from the nationwide State Broadband Leaders Network. Our primary policies of interest are those related to: (1) availability of state-level funding, (2) existence of a state-level broadband office/task force with full-time employees, and (3) restrictions on municipal/cooperative broadband provision. We find a positive and significant impact of state-level funding programs on general (and fiber) broadband availability, and a negative impact of municipal/cooperative restrictions. The findings are similar when the analysis is restricted to the rural portions of counties.

And to cut to the chase, here are the numbers indicating the impact of policy support…

  • We find that state-level funding programs increase general broadband availability by 1–2 percentage points.
  • We find that municipal/cooperative restrictions decrease general broadband availability by 3 percentage points.

Lack of good broadband access is a strong predictor of childhood poverty: true in MN too?

Steven Ross at Broadband Communities has taken a deep dive into broadband and children in poverty and kids who take more than four years to complete school (or education). He looks at the top and bottom counties in each state in aggregate, he found…

Lack of good broadband access is a strong predictor of childhood poverty. That’s the finding of Broadband Communities’ recent analysis combining county-level broadband data it has collected since 2010 with comprehensive, county-level poverty data compiled by the nonprofit organization Save the Children.

These are pre-COVID numbers but he ascertains that the situation is likely worse now…

All data in this article refers to a pre-COVID United States, but broadband disparities now are even worse than they were at the start of 2020 given work-from-home and distance-learning demands brought on by the pandemic. In urban areas where access is available but not always affordable, providers usually have made it available free or at low cost during the COVID-19 lockdown. Almost half of all rural homes have no broadband at any price.

Ross goes on to look at rural versus metro and other interesting factors, but I’m always interested in the Minnesota perspective. So I’m taking a deeper dive based on his study. Because we have local mapping, I have used those rankings (25/3 and 100/20) to look at broadband. And I found percentage of children in poverty a little differently; I used SAIPE State and County Estimates for 2018 (same year as Ross) and their percentage of children (0-17) in poverty. I can pretend this was a check and balance but really it was an easier way to get very similar info with less math for me.

I looked at the top and lowest broadband ranking counties and it aligns with Ross’s work. The top counties had average lower poverty rates and the top counties with faster broadbnd (100/20 vs 25/3) had the lowest averate rates:

  1. Top 10 counties for broadband (100/20), the average poverty rate is 13.54 percent
  2. Bottom 10 counties for broadband (100/20), the average poverty rate is 16 percent
  3. Top 10 counties for broadband (25/3), the average poverty rate is 14.85 percent
  4. Bottom 10 counties for broadband (25/3), the average poverty rate is 16.47 percent
  5. The state poverty rate is 18 percent

I’ve included a table below that compares the broadband coverage and poverty rate. To get some broad swth view, I’ve highlighted in yellow the lower half of the poverty rates and the higher percentages of broadband coverage. So you’d like to see your county come up all yellow.

As Ross points out in his report, this doesn’t tell us cause or effect but there does seem to be a connection.

OPPORTUNITY: Growing Healthy Digital Equity Ecosystems Questionnaire

I am sharing the following opportunity from Colin Rhinesmith Simmons University to take their Growing Healthy Digital Equity Ecosystems Questionnaire/survey…

You are being invited to participate in a research study to examine how organizations that work with groups in their community to promote digital inclusion have responded to the challenges of COVID-19. The goal of the study is to provide data and evidence to help NDIA members, funders involved in supporting COVID-19 relief efforts in local communities, as well as local, state, and federal policymakers to develop more effective digital equity strategies nationwide. Findings from the study will also be useful for stakeholders working to promote digital equity and racial justice in communities struggling with poverty during COVID-19 and after the pandemic ends.

The survey took me about 5 minutes; it make take longer depending on your answers I imagine. Going through the survey it would be nice to have a broad swath of people take it to see how people are working on digital equity at a time when the gap seems to be deepening  exponentially.

 

MN broadband access has increased 4.4 percent since COVID

Whistle Out looking at increase in broadband speeds by state across the country…

As you can see Minnesota’s speed has increased 4.4 percent. Here’s their methodology…

We looked at over 717,000 internet speed tests, comparing the average results per state from the period prior to the COVID-19 U.S. outbreak (mid-January to mid-March 2020) to the period after the pandemic started (mid-March to early July 2020). We excluded cellular data speed tests, focusing only on home broadband internet connections.

They note, while looking at statistics nationally, that the increase might be increase in customer tier selection more than increased deployment or upgrades…

Surprisingly, overall average internet speeds across the United States have increased throughout the pandemic, from 84.9 Mbps to 94.6 Mbps—despite the surge in bandwidth demand from more Zoom-ing, streaming, gaming, and more.

One potential reason for the upward shift could lie in the fact that consumers have upgraded their internet plans to faster ones, thereby raising the overall average for home internet speeds. Some internet service providers, like Cox, have also increased overall internet speeds for some plans in response to the pandemic.

Telehealth great for people with broadband – reimbursement a factor of cost or value?

Alexandria Echo Press reports on a recent survey of healthcare during the pandemic…

Minnesotans experienced adverse health outcomes due to delays in care, the use of telehealth has surged, the bottom lines of physician practices in Minnesota were hurt significantly during the first months of the COVD-19 pandemic, and doctors fear the next wave of the virus.

These are a few of the key findings of a recent study commissioned by the Minnesota Medical Association (MMA) on the impact of the pandemic on physician practices.

The study, “Minnesota Physicians Respond to COVID-19,” is based on responses to two surveys – one sent to Minnesota physicians (the 641 responses represent a +/- 4 percent margin of error at 95 percent confidence interval) and one sent to medical practice administrators (92 responses). Surveys were completed between June 16 and July 13, 2020.

They outline the impact of telehealth…

Not surprisingly, the use of technology increased dramatically during the pandemic, the study found. In 2019, practice administrators reported that approximately 3 percent of patient encounters were conducted via telehealth including e-visits, phone, and video visits. Since March 2020, that number has increased to 28 percent, an increase of 833 percent.

Eighty-four percent of physicians reported that patients were satisfied or very satisfied with telehealth visits. A similar proportion of physicians (83 percent) said telehealth is meeting the care needs of their patients. “Telehealth is a lot like doing house calls,” commented one respondent. “I am a guest in their home and the patient is much more comfortable. I hear the sounds of their life.”

Nearly three-quarters of physicians said they think it is important to retain telehealth as a care delivery method, but changes are needed for that to continue. Seventy-eight percent reported uncertainty around ongoing reimbursement by insurers as a barrier to broader telehealth adoption and use.

Another critical barrier to telehealth adoption is on the patient side – 73 percent of physician respondents noted that patient access to technology and patient access to broadband (60 percent) were moderate to significant barriers to broader telehealth use.

“We’re glad to see the expanded use of telehealth,” Stelter says. “However, not all patients can currently access it. Many Minnesotans don’t have access to broadband. Variation in technology platforms can also drive patient comfort and use. For telehealth to be truly helpful, everyone needs to have the ability to use it effectively. This is yet another example of the health care disparities that exist in Minnesota.”

The emphasis above is mine. They also discuss the financial situation for healthcare facilities, which is down. Some of that may be due to people accessing less care. But it may also be a reason to look at cost and reimbursement for telehealth. Maybe the start is to quit looking at cost and start looking at value! What is it worth to keep patients out of the healthcare facilities and hospitals? What is it worth to have a house call over driving to the nearest hospital? What is the cost versus value of having healthcare access in your community? We may need to change the equation?

2020 version of ILSR’s Profiles of Monopoly: Big Cable and Telecom

The Institute for Local Self Reliance first published their Profiles of Monopoly: Big Cable and Telecom in 2018. They have updated it annually since then and have recently posted the 2020 edition. They took a look at the big national providers: Comcast, Charter, AT&T, Verizon, CenturyLink, Frontier and  Windstream.

ILSR focuses on local community autonomy or at least control so they have a perspective. They do a good job collecting and analyzing data. Here are their conclusions…

The broadband market is broken. Comcast and Charter maintain an absolute monopoly over at least 47 million people and millions more only have slower and less reliable DSL as a “competitive” choice. Some 52 million households (about 132 million people) subscribe to these cable companies, whereas the five largest telecom companies combined have far fewer subscribers — only around 30 million households (about 75 million people). The big telecom companies have largely abandoned rural America — their DSL networks overwhelmingly do not support broadband speeds — despite many billions spent over years of federal subsidies and many state grant programs.

These are our key findings with potential for more research:

Real Competition Drives Investment

The telecom companies have invested in Fiber-to-the-Home in areas where they face competition, which are generally more urban areas. The advent of Google Fiber in 2011 further increased the competition in urban markets.55 Efforts to increase investment from the largest firms in more rural areas have largely failed. Though states have varied regulations, the same trend results in every state — investment by the large ISPs is correlated to competition rather than the regulatory environment. This reality does not suggest that competition between a cable monopoly and a telephone monopoly is sufficient for high-quality Internet access, but it clearly helps to ensure connections at the minimum definition of broadband.

Big Cable Companies Dominate

Cable networks are capable of delivering high-speed broadband to everyone within their service area, a legacy of the local franchising requirements that often required universal service or at least service to all areas with a specified density of housing.56 More than half of the states have since removed local authority to negotiate such provisions but they bear some responsibility for the far-reaching cable networks. In the years since we published the first edition of this report in 2018, the large cable companies have continued to gain broadband subscribers while the major telephone companies lose market share. By the end of 2019, the cable industry as a whole had 67 percent of the broadband market.57 The FCC statistics suggest Charter and Comcast face more competition than they did in our last report, but we suspect competition has only touched some homes in many of the new census blocks that appear to have a choice in providers now.

Big Cable and Telecom Focus on Urban Markets

The big cable and telecom companies fight over urban customers, not rural customers. More than 98 percent of the urban population (about 259 million people) have access to broadband, according to the FCC’s 2020 Broadband Deployment Report, which analyzed data from December 2018.58 About 4 million urban residents, however, remain without broadband access. In rural areas, less than 78 percent of the population (50 million people) have broadband access, leaving more than 14 million rural residents without highspeed Internet access per the FCC but as many as 42 million according to another analysis.59

What Should We Ask in our Next Internet Use Survey?

I wanted to share the following from an NTIA email to data users. If you have some thoughts, you should tell them…

For more than 25 years, NTIA has been surveying the American public about its computer and Internet use, in partnership with the Census Bureau. Our most recent NTIA Internet Use Survey went into the field in November 2019, with more than 50 questions administered to approximately 50,000 households across the United States. In anticipation of conducting future surveys, NTIA is seeking recommendations from the public about how we can improve our survey and make it as relevant as possible. Are there questions we previously asked that should be changed or deleted? Are there any questions that we should be adding? We want to hear from you. | Read the complete blog post >>

By submitting your ideas for our next set of questions, you can help ensure that our survey is keeping up with evolving technologies and any new policy challenges that arise. After digesting your comments, NTIA will draft a revised survey instrument to use in the future. Beginning this fall, experts from the Census Bureau will conduct cognitive testing of our draft survey, which will help us learn what questions may cause confusion or elicit inaccurate responses. You can find more information and instructions for submitting your comments in the official Request for Comments. | Read the Request for Comments >>

In the meantime, we will continue to analyze the results of our November 2019 survey. In our initial post on the results, we shared that seniors and other demographic groups reported encouraging increases in Internet use, and that Americans in general were using a larger and more varied range of devices.

For people considering a move to a rural area … Broadband is even more important than politics.

Recon Analytics recently published an article, Broadband 2020: how the pandemic changed usage and priorities that is recommended reading for any rural community looking to attract new people.

They start out with the notion that now that as teleworking or telecommuting becomes a greaer norm more people are looking at moving…

A slight majority (50.9%) of Americans that can telecommute are contemplating moving to a smaller city or town as the pandemic has prompted many Americans to reevaluate their priorities and living conditions.

They highlight the reasons that people won’t move…

Clearly, a community can’t do much about the first part – a pay cut. But broadband and healthcare are things a community can change. It takes money, planning, a provider – well most readers will know exactly what it takes, but knowing how many people are looking to move and that broadband and healthcare are qualifiers to choosing a community, highlights both broadband and healthcare costs as investments.

Another important factor, is the definition of broadband…

Where does your community stand with broadband access? The MN County broadband maps came out earlier this summer – so you can find out, which means potential residents can find out too. Will your community make the cut? I’ve talked to enough communities to know that often the answer is that part of the community is well served and parts are not.

When it comes down to it – the research is even more drastic when you get to the household level…

While the lack of widely available broadband is a significant hurdle for cities and towns to attract new residents, it is almost outright disqualifying for housing options: 77.5% of respondents would not move to a place, like a house or apartment, that does not have broadband.

The Cost of Connectivity? Definitely more in the US

New America has released their (sometimes) annual report on the cost of broadband. They look at a number of factors but it’s their statement on affordability in the US is most sobering…

Based on our dataset, the most affordable average monthly prices are in Asian and European cities. Just three U.S. cities rank in the top half of cities when sorted by average monthly costs. The most affordable U.S. city—Ammon, Idaho—ranks seventh. The overwhelming majority of the U.S. cities in our dataset rank in the bottom half for average monthly costs. Internet policy scholar Jonathan Sallet recommends that $10 per month is an affordable benchmark for low-income households. Only six plans in our U.S. dataset meet this $10 benchmark at any speed tier (only four meet Sallet’s 50/50 Mbps recommendation), and all six are offered in Ammon. Out of 290 plans in our U.S. dataset, 118 have advertised initial promotional prices of $50 and under—and only 64 of these plans advertise speeds that meet the current FCC minimum definition for broadband. In addition, some ISPs have abandoned low-income neighborhoods in a form of “digital redlining.” Moreover, COVID-19 has exacerbated a longstanding digital divide that disproportionately affects low-income households and Black, Indigenous, and people of color (BIPOC) communities. As jobs and incomes are lost, this affordability crisis is poised to worsen. Congress and the FCC must take immediate action to stop digital redlining and help more people get online.

Stats on telehealth – big on virtual visits, less so on EHR

Becker’s Hospital Review reports…

Only 31 percent of hospitals and health systems are using capabilities within their EHR systems to conduct telehealth visits, according to a recent Sage Growth Partners report.

Sage Growth Partners during the week of May 25 surveyed 150 respondents representing various executive roles at hospitals and health systems across the U.S. Respondents were asked to describe their virtual care operations and strategies.

Three report insights:

  1. Forty-eight percent of respondents said they are using third-party software such as Zoom and Skype for telehealth visits.

  2. When asked what key tech solutions are critical to their organizations, 85 percent of execs said virtual care, 52 percent said hospital communication and 43 percent said supply chain automation.

  3. Prior to the COVID-19 pandemic, 80 percent of hospitals provided less than 10 percent of their care virtually. However, only 11 percent of hospital leaders predict that in 24 months they will go back to their pre-pandemic rates of virtual care.