Wabasha County to invest $1 million American Rescue Plan funds on broadband

Post Bulletin reports

Wabasha County Administrator Michael Plante said the county board voted to commit $1 million of its $4.2 million American Rescue Plan money to expanding rural broadband access. While counties across the country still have questions on the federal guidelines for spending those funds – Plante said the county will hire a consultant to ensure it follows those guidelines to the letter once their hammered out – he envisions a grant program where internet providers can apply through a request for proposals, letting the county know what projects they prioritize in rural areas for their clients.

“Land-wise, a significant portion of the county is either unserved or underserved,” Plante said. “Primarily, we’re good in the cities. Population-wise, a substantial portion does have those internet capabilities. But businesses and families in the more rural areas need access to that.”

According to the Minnesota Department of Employment and Economic Development, underserved areas are places with wireline broadband of at least 25 Mbps download and 3 Mbps upload, but less than 100/20 Mbps. Unserved areas are places with no wireline broadband of at least 25/3 Mbps.

Not everyone pushed for broadband…

Not everyone was supportive of the plan to spent $1 million on rural broadband. Wabasha County Commissioner Brian Goihl said that between the lack of guidance from the federal government, the fact that the county has until Dec. 31, 2023, to put plans in place and another three years for project completion, and other pressing spending needs in the county, he’d prefer to spend the $1 million on other projects.

FCC announces second ECF application window; $5.137 billion requested in first window

An announcement from the FCC…

The FCC announced  that requests for $5.137 billion in funding to support 9.1 million connected devices and 5.4 million broadband connections were received during the Emergency Connectivity Fund Program’s initial filing window.  The window, which closed August 13, 2021, attracted applicants from all 50 states, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands and the District of Columbia – including schools and libraries in both rural and urban communities seeking funding for eligible equipment and services received or delivered between July 1, 2021, and June 30, 2022.  Additional information about the demand at the state level can be found here.

In view of outstanding demand and the recent spike in coronavirus cases, the FCC will open a second application filing window for schools and libraries to request funding from the roughly $2 billion in program funds remaining for connected devices and broadband connections for off-campus use by students, school staff, and library patrons for the current 2021-22 school year.  The second window will open on September 28 and run until October 13.  Eligible schools and libraries will be able to apply for financial support to purchase eligible equipment and services for students, school staff and library patrons with unmet needs.

ECF Demand: Minnesota

  • Amount Requested for Equipment: $50,636,008.93
  • Amount Requested for Services: $12,232,818.32
  • Total Funding Requested: $62,868,827.25

Telehealth in MN – how to find it, what insurance pays for, how to get it

The UpTake has a useful article on the how-tos and some of the whys of telehealth policy during/because of COVID. It might be helpful to folks you know (or you) but also I think it’s helpful as a policymaker or community leader to think about telehealth from the perspective of the patient or provider.

How does insurance coverage for telehealth work in Minnesota since the pandemic…

Minnesota has been following the federal recommendations for COVID-19 emergency telehealth coverage since March 2020, including requiring that insurers cover telehealth sessions at the same rate as in-person appointments. At the time this article is written, clients’ homes are still considered an appropriate originating site for telehealth appointments.

This means that your insurance company should continue to cover your telehealth sessions at this time, and you would have the same out-of-pocket expense as if you had come to the office in person. It also means that your insurance will not require you to travel to an approved originating site.

Currently, Minnesota’s emergency telehealth coverage is tied to the federal state of emergency. Coverage is ongoing, as the pandemic is ongoing. States that have made changes to these policies have given a minimum of 30 days notice, and providers have a responsibility to be attentive to these regulations. As changes occur, providers will give their clients as much notice as possible about how this might impact their treatment and options for services.

How does it work for telehealth work for providers…

The state of Minnesota requires that clinicians submit a statement indicating that they are qualified to provide telehealth services. This is something that clients do not need to do, and the therapist has the responsibility to take this step prior to providing telehealth services.

What if my provider is not in MN…

Since before the pandemic began, licensure requirements for mental health professionals have been based on the client’s physical location at the time of service. This means, as a therapist, I must be licensed where my client is when they check in for a telehealth session.

Previously, Minnesota had allowed out-of-state providers to offer telehealth services to Minnesota residents due to the COVID-19 state of emergency. This has been important for those living near boarders who had received in-person services in another state but now needed to be seen from home for safety reasons. However, this reciprocity is no longer in effect.

This means that providers in South Dakota, North Dakota, Iowa, and Wisconsin now need their clients to either come in person to the office or use an approved originating site across the border based on that state’s guidelines.

How can I get the services I need…

If you are uninsured, Walk-In Counseling Center continues to offer telehealth services in Minnesota, and Open Path Collective offers a national therapist directory to help individuals find low-cost therapy services.

If you have insurance, you can reach out to your insurance company to see which Minnesota providers are paneled with your plan. You can ask questions about which services are covered and whether you have to meet a deductible or will have a copay for each visit.

Pew Reports on the Internet and the pandemic: almost half with broadband said they had problems with speed

Pew Research reports…

Results from a new Pew Research Center survey of U.S. adults conducted April 12-18, 2021, reveal the extent to which people’s use of the internet has changed, their views about how helpful technology has been for them and the struggles some have faced.

The vast majority of adults (90%) say the internet has been at least important to them personally during the pandemic, the survey finds. The share who say it has been essential – 58% – is up slightly from 53% in April 2020. There have also been upticks in the shares who say the internet has been essential in the past year among those with a bachelor’s degree or more formal education, adults under 30, and those 65 and older.

A large majority of Americans (81%) also say they talked with others via video calls at some point since the pandemic’s onset. And for 40% of Americans, digital tools have taken on new relevance: They report they used technology or the internet in ways that were new or different to them. Some also sought upgrades to their service as the pandemic unfolded: 29% of broadband users did something to improve the speed, reliability or quality of their high-speed internet connection at home since the beginning of the outbreak.

They looked into the impact of the digital divide too…

Some Americans’ experiences with technology haven’t been smooth or easy during the pandemic. The digital divides related to internet use and affordability were highlighted by the pandemic and also emerged in new ways as life moved online.

For all Americans relying on screens during the pandemic, connection quality has been important for school assignments, meetings and virtual social encounters alike. The new survey highlights difficulties for some: Roughly half of those who have a high-speed internet connection at home (48%) say they have problems with the speed, reliability or quality of their home connection often or sometimes.2

Beyond that, affordability remained a persistent concern for a portion of digital tech users as the pandemic continued – about a quarter of home broadband users (26%) and smartphone owners (24%) said in the April 2021 survey that they worried a lot or some about paying their internet and cellphone bills over the next few months.

From parents of children facing the “homework gap” to Americans struggling to afford home internet, those with lower incomes have been particularly likely to struggle. At the same time, some of those with higher incomes have been affected as well.

Affordability and connection problems have hit broadband users with lower incomes especially hard. Nearly half of broadband users with lower incomes, and about a quarter of those with midrange incomes, say that as of April they were at least somewhat worried about paying their internet bill over the next few months.3 And home broadband users with lower incomes are roughly 20 points more likely to say they often or sometimes experience problems with their connection than those with relatively high incomes. Still, 55% of those with lower incomes say the internet has been essential to them personally in the pandemic.

Essentia Health in Duluth gets nearly $1 million from FCC for telehealth

The FCC reports

The Federal Communications Commission today approved an initial set of 62 applications for funding commitments totaling $41.98 million for Round 2 of its COVID-19 Telehealth Program.  Health care providers in each state, territory, and the District of Columbia, including those previously unfunded in Round 1, will use this funding to provide telehealth services during the coronavirus pandemic.  The FCC’s COVID-19 Telehealth Program supports the efforts of health care providers to continue serving their patients by providing reimbursement for telecommunications services, information services, and connected devices necessary to enable telehealth during the COVID-19 pandemic.

“During the COVID-19 pandemic, access to health care has proven to be not only a national issue, but also a local issue, and it is imperative that every community is given the tools to access this care as safely and effectively as possible.  The FCC is committed to ensuring that every state and territory in the United States receive funding as part of this program,” said FCC Acting Chairwoman Jessica Rosenworcel.  “The FCC took action earlier this year to establish a system for rating applications in Round 2, factoring in the hardest hit and lowest-income areas, Tribal communities, and previously unfunded states and territories.  Now even more doctors and nurses in every corner of our country can establish or expand telehealth services to support patients and their families.”

This first set of awards will go to applications that qualify for the equitable distribution step, as required by Congress and outlined in the FCC’s rules, to ensure nationwide distribution of funding to health care providers in each state, territory, and the District of Columbia.  This step funds the highest-scoring applications in every state, territory, and the District of Columbia plus the second highest-scoring application from the states and territories that did not receive funding in Round 1, if multiple applications were submitted from those areas.

Round 2 is a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act.  Now that funding has been committed to the highest-scoring applications from each state, territory, and the District of Columbia, the next funding awards will commit funding to the highest-scoring applications, regardless of geography, until at least $150 million has been committed.  The FCC’s Wireline Competition Bureau will then announce an opportunity for all remaining applicants to supplement their applications, as required by Congress.  After all remaining applicants have the opportunity to supplement, the remaining program funding will be committed.

Here’s the Minnesota recipient…

Essentia Health in Duluth, an integrated health system in Minnesota, serving patients in the upper Midwest, was awarded $981,204 to support the acquisition of remote monitoring devices and video carts with peripheral cameras and stethoscopes/EKGs for care during the pandemic, and to increase wireless broadband coverage at eight clinics to allow for additional space for telehealth patients.

There’s a hiccup preventing some people from getting Emergency Broadband Benefit (EBB)

Public Knowledge reports

Throughout the COVID-19 pandemic in our country, millions of Americans cannot connect to the internet because they can’t afford to, preventing them from going to school, working, accessing government benefits and connecting with friends and family. To remedy this problem, Congress created the Emergency Broadband Benefit (EBB), which offers low-income consumers a $50 discount on their internet bills. Unfortunately, because of a shortcoming in the National Verifier, the database used to verify consumer eligibility for the program, many of those in need do not access this important benefit, ultimately keeping the digital divide open.

Let’s paint the picture of how. Imagine you can’t afford broadband, and learn that, because you participate in a relevant federal program (like SNAP, Medicaid, free/reduced school meals, etc.), you are eligible for the EBB. Huzzah! To apply, you are told to use the Lifeline National Verifier. The Verifier is intended to be a one-stop shop to verify consumer eligibility for the EBB based on their participation in a different federal program. The idea is that eligible consumers enter their information on the National Verifier website and are approved if the database shows they do, in fact, participate in one of the qualifying federal programs. However, the Verifier doesn’t always work that way, because it doesn’t have data about participation in all qualifying programs. So, frustratingly, if the Verifier doesn’t have data about the program you quality through, you have to go through a whole big process to get documentation that you are eligible. Since you don’t have a lot of time on your hands as the head of a household, and don’t have the internet, you never end up enrolling and stay without internet.

The article goes on to explain how this happen – in short info on the relevant federal programs is not necessarily centrally or easily accessible. That leaves the onerous task of proving need to the potential recipient, who likely has issues accessing broadband if they are applying for EBB. I can only imagine the frustration of the user who knows they get SNAP (for example) but it’s not coming up on the database. We’ve all been there when something doesn’t work online and for many the first response is to assume user error.

The author does offer a solution…

How do we solve this problem? Congress must step in by enacting legislation to require that any agencies that have data share it with USAC in a timely manner, and to clarify that data sharing for verification purposes is legal. To the extent Congress needs to exempt such data sharing from existing privacy laws, it should include that in the legislation. Such laws are intended to protect a recipient’s privacy, but are not intended to be a roadblock to participation in other benefits programs. Moreover, the data to be shared is sufficiently minimal that it does not carry with it the broader privacy risks addressed by our privacy laws. Absent Congressional action, we will be left with a patchwork system, enabling some consumers to breeze through the application process, while others cannot.

The ease of enrollment directly correlates to the number of consumers that enroll. If we want to ensure that the EBB (and any future broadband subsidy) can fulfill their purpose of getting low-income consumers connected and narrowing the digital divide, Congress must ensure that all potential participants can be automatically verified through the Verifier.

Appleton, Benson, Madison and Redwood County get grants from MN DEED

The West Central Tribune reports

The Department of Employment and Economic Development recently announced that 15 Minnesota communities, including Appleton, Benson, Madison and Redwood County, will receive significant grants to improve broadband services and make other community improvements. The grants are part of the federal CARES Act.

AppletonBenson, Madison and Redwood County will receive grants ranging from $678,000 to $3.7 million.

Details on the grants…

According to DEED, the city of Appleton received $3,699,000 for broadband improvement and commercial rehabilitation, the city of Benson received $678,000 for retrofitting buildings, the city of Madison received $2,560,000 for broadband improvements and Redwood County received $1,715,607 for broadband improvements.

Greenwood Township looks at local, state and federal options for broadband funding

The Timberjay reports on broadband funding and hopes for Greenwood Township…

Chairman Mike Ralston told the Greenwood Town Board that the township’s $5.5 million request for broadband funding is part of the just-approved Senate Infrastructure bill, having been put on the list by both Senators Tina Smith and Amy Klobuchar.
This funding, if approved by the House of Representatives and signed by President Joe Biden, would provide the vast majority of the estimated $6.6 million project.
The township will also be applying for grant funding from a new St. Louis County broadband program that will award a maximum of $400,000, and grant dollars from the IRRR.
Greenwood Township also received $50,316 in federal funding from the American Rescue Plan Act, but whether the board will set aside those funds for a local match to the proposed broadband project is yet to be determined. The township will receive a similar amount in 2022.

Supervisor Sue Drobac asked Ralston why other board members weren’t informed that the township had received the American Rescue Act funding as of the end of July. She said that members of the township’s broadband committee had submitted their own application.
“We need more communication,” Drobac said. “We spent a lot of time on this.”
Ralston agreed, and said he had sent the application to Deputy Treasurer Tammy Mortaloni to complete.
“There was a long list of COVID-related items we could use it for,” he said.
The board asked the broadband committee, which includes Drobac and Supervisor Barb Lofquist, to be in charge of submitting the grant to the new St. Louis County broadband program, which will distribute a total of $1.75 million in American Rescue Plan monies for broadband projects. That grant application is due in September.
The board voted down a motion by Drobac to place the $50,316 in American Rescue Plan dollars into a restricted broadband account, with Ralston and Supervisors Carmen DeLuca and Paul Skubic all voting against.
The board then approved, unanimously, a motion that any grants written specifically for broadband infrastructure would go into a restricted account. This still leaves the township the option of using some or all of the $50,316 for the broadband project.
A survey for township residents to gauge interest in receiving broadband should be available on the township website, www.greenwoodtownshipmn.com, and all township property owners will be mailed a letter urging them to complete the study, or to return a paper copy as soon as possible.

DEED announces $34.6 Million Awarded in Small Cities Coronavirus Funding

From the Minnesota Department of Employment and Economic Development

The Minnesota Department of Employment and Economic Development (DEED) today announced $34,656,956 in grants to 15 Minnesota cities and counties across the state from the Small Cities Coronavirus Community Development Block Grant Program (CDBG-CV).

As part of the federal Coronavirus Aid, Relief and Economic Security Act (CARES Act), Minnesota received a special allocation to address community needs to prevent, prepare for and respond to the COVID-19 pandemic.

Most of the funding – nearly $32.2 million – will be used for broadband improvement projects. Projects under CDBG-CV are not associated with the Border-to-Border Broadband Development Grant Program managed by the Minnesota Office of Broadband Development.

Other uses of this funding will include housing assistance, food shelf assistance, retrofitting buildings and commercial rehabilitation projects. These uses were determined through an open community input process and approved by the Housing and Urban Development Agency (HUD).

“The pandemic has made clear how vital broadband is to the lives of Minnesotans and to the economic vitality of our state,” said DEED Commissioner Steve Grove. “These grants will help communities fund broadband and other important projects as we write the next chapter of our economy.”

Applications were rated according to need, impact, and cost effectiveness. Funds are intended for projects that are focused on the locality and that will be used primarily for low-and-moderate income residents. You can find out more about CDBG grants on the DEED website.

The following 15 cities and counties received CDBG grants:

Aitkin County , $4,823,654
Broadband improvement

City of Appleton , $3,699,000
Broadband improvement and commercial rehabilitation

City of Benson , $678,000
Retrofitting buildings

City of Bemidji , $600,000
Retrofitting buildings

City of Bloomington , $154,430
Housing assistance and food shelf assistance

City of Ceylon , $983,105
Broadband improvement

Crow Wing County , $4,495,340
Broadband improvement

City of Dodge Center , $3,142,747
Broadband improvement

Faribault County , $2,886,206
Broadband improvement

City of Harmony , $2,245,849
Broadband improvement

City of Madison , $2,560,000
Broadband improvement

City of Slayton/Murray County , $2,822,278
Broadband improvement

Pine County , $3,743,390
Broadband improvement and retrofitting buildings

Redwood County , $1,715,607
Broadband improvement

City of Wabasha , $107,350
Commercial rehabilitation

 

A look at broadband needs in rural MN: Walnut Grove, Redwood County and Pine County

MN Public Radio takes a look at broadband on the frontlines in rural Minnesota. In Walnut Grove…

The 31-year-old crop insurance adjuster works on a computer set up in his living room, but sometimes he has to travel to the library in a neighboring town for a steady internet connection. Other times, he uses a mobile hot spot. He gets by, Malmberg said, and others he knows, work with less.

“Up until four years ago, I think, my parents had dial-up,” he said. “They basically have dial-up still. They have 3.5 megabits per second is their [download] speed. No Netflix, no Amazon Prime. Only email, and the occasional YouTube video.”

In Redwood County…

“Internet is now as necessary as electricity and water,” said Briana Mumme, Redwood County economic development coordinator. “I mean, like these are just part of how we do life. You just have to have access to it.”

About 90 percent of households have a computer statewide, according to the Blandin Foundation, and 81 percent have a laptop; 76 percent have a smartphone and 59 percent have a tablet. But, there are many areas in Minnesota, Mumme said, where access to high-speed internet is limited and working remotely and distance learning have run into problems, which was the case for one college student she knows who moved back home during the pandemic.

“In order for him to attend school, he literally had to drive to his grandparents house, back into town where the bandwidth was bigger or more robust,” she said. “So he could actually do school.”

In Pine County…

Other rural counties are also competing for better broadband and have seen the shift in how their communities are viewing the necessity for it. Lezlie Sauter, Pine County economic development coordinator, said COVID-19 revealed a lot of disparities where better internet access was needed in northern Minnesota.

“I think that the pandemic opened up our eyes to, ‘we have to be able to pivot and do work online,’ ” Sauter said. “I don’t think our community was prepared for it. I think some people were, but most of us viewed the internet and broadband as a luxury and it’s something we use to stream video and Netflix and all those things. But, we did not see how important it would be to keep conducting business.”

How could the federal Infrastructure bill impact broadband in MN?

KARE11 News reports

The Senate’s infrastructure bill would bring billions of dollars in improvements to Minnesota.

The $1 trillion infrastructure package received bipartisan support in the Senate, passing 69 to 30 with 19 Republicans joining Democrats. The bill, which still needs to pass the House, includes $550 billion in new spending.

U.S. Senators Amy Klobuchar (D-Minn.) and Tina Smith (D-Minn.) both voted in favor of the bill.

For broadband in Minnesota…

The plan would bring at least $100 million for broadband internet systems in communities across the state and provide access to at least 83,000 residents currently without broadband access.

“We found out in really glaring technicolor during the pandemic that we have 144,000 households in our state that don’t have high speed broadband. The school superintendents would say in all of the rural areas something like 10% to 15% of their kids couldn’t even do their homework over the internet because they had such slow internet,” said Sen. Klobuchar, during a press conference Wednesday afternoon at Nicollet Island Pavilion in Minneapolis.

La Crosse Tribune goes into the broadband aspects…

More radical industry changes laid out in the Biden administration’s original $100 billion plan, like promoting alternatives to the dominant phone and cable industries and hinting at price regulation, didn’t survive bipartisan negotiations over a bill that had to attract Republican support. Among the bill’s big winners, in fact, are those same internet service providers.

There’s a focus on affordability…

The Senate bill would provide about $14 billion toward a $30 monthly benefit that helps low-income people pay for internet, extending a pandemic-era emergency program.

“What makes this historic is the focus on affordability,” said Jenna Leventoff of Public Knowledge, which advocates for more funding for broadband. The bill, should it become law, is “going to help a lot of people that were otherwise unable to connect.”

An existing program, known as Lifeline, aimed to help solve this affordability issue before. But it only provides $9.25 a month, which doesn’t go far for internet plans. It has also been a target of Republicans, who say it has fraud and abuse problems.

Industry groups have also advocated for a permanent broadband benefit. Broadband companies, if they choose to participate, will gain additional customers. The program is “a plus for all ISPs,” said Evercore ISI analyst Vijay Jayant.

And network deployment…

The bill provides about $42 billion in grants to states, who in turn will funnel it to ISPs to expand networks where people don’t have good internet service. Companies that take this money will have to offer a low-cost service option. Government regulators will approve the price of that service.

The bill requires that internet projects come with minimum speeds of 100 mbps down/20 up, a big step up from current requirements. But some advocates are concerned that it’s still too slow, and argue that the federal government may have to spend big again down the line to rebuild networks that aren’t up to par for future needs.

Cable companies are also happy that the funding is primarily dedicated to areas that don’t currently have broadband service. Some advocates had hoped the government would step in and fund competition to cable so that people had more choices. Others saw that as wasteful.

The Biden administration’s initial plan promised to promote local government networks, cooperatives and nonprofits as alternatives to for-profit phone and cable companies. Under the Senate’s plan now, such groups aren’t prioritized, but they can still get money from states for networks. The telecom industry has lobbied against municipal networks; about 20 states restrict them.

Senate negotiators also left loopholes in language around an attempt to end what’s known as “digital redlining” — when telecom companies provide upgraded internet service in wealthier parts of town but leave others without good service. The bill says the FCC must create rules to stop this practice, “insofar as technically and economically feasible.” But the whole reason telecoms leave some areas with subpar service is because those neighborhoods are not as profitable, said Leventoff.

Study shows need for upload increased during pandemic – and it’s likely to continue

Gov Tech reports

The voices of Americans seem to make this clear: If government is going to fund broadband infrastructure, it should invest in solutions with higher maximum speeds, particularly upload speeds that have become so critical in the wake of COVID-19.
A recent study, published in the Journal of Information Policy, pushes back against the perspective that the Internet, for the most part, held up “just fine” during the pandemic. Looking at consumer complaints directed to the Federal Communications Commission during the first few months of the pandemic, the study found that Internet complaints jumped up significantly after COVID-19 shut down most of the country.
The study also examines speed data showing that upload speeds in particular suffered until the last quarter of 2020, perhaps due to the increase in use of videoconferencing tools among families working and learning from home.

The track three types of users…

The researchers suggest there are three types of Internet users in America.
“The Internet made it easy for some people to work, go to school, and interact with loved ones safely without leaving their homes,” the article reads. “Those lucky individuals maintained an extraordinary degree of normalcy and safety despite a pandemic that in some regions disrupted nearly every aspect of daily life. At the other extreme were those who normally used the Internet outside the home. Their access to the Internet was severed just when they needed it most … In between were households that did have Internet access, but not at the quality of service that would make all of these activities easy.”

They take a look at what’s happening in Minnesota…

Angie Dickison, executive director of broadband development for the Minnesota Department of Employment and Economic Development, said inquiries from citizens without broadband at all have remained constant since the onset of the pandemic, but more people than usual have contacted the state about “access to better upload speeds.”
Dickison also noted that the Internet needs of senior citizens have become quite apparent over the last year and a half. She recalled a letter that her office received from an elderly woman.
“Through the pandemic, she was diagnosed with cancer and talked about how important it was for her to have broadband, not just to have access to health care but to stay connected with family and friends,” Dickison said.
To further illustrate the newfound importance of upload speeds, both Ivey and Dickison mentioned the U.S. Department of the Treasury’s interim final rule for spending American Rescue Plan dollars on broadband. The rule states that broadband projects should result in “symmetrical upload and download speeds of 100 Mbps.” If that standard can’t be met immediately, the download speed must still be at least 100 Mbps, and the upload speed must hit 20 Mbps and be scalable to 100 Mbps.

The report itself goes into greater detail and recommendation for policymakers…

These changes also substantially increased Internet traffic. The Internet remained usable under this load, but performance was degraded, primarily for upstream traffic. ISPs were accustomed to carrying streaming video to tens of millions of homes every evening, so there was already capacity to handle much of the downstream traffic for videoconferencing, but not the upstream. That is presumably why upstream data rates at midday fell by roughly a third during the pandemic, and why complaints about speed increased by 176%. These increases were much greater in services that offer highly asymmetric service, for example, 291% for cable and 213% for satellite, whereas the increase for slow but symmetric DSL was just 15%. Today, people tend to focus primarily on the downstream capabilities of Internet services, as if the upstream did not matter. The implications for ISPs are obvious. Even after COVID-19 has been tamed, we will probably see more people working and going to school from home than before the pandemic. To prepare for that possibility, ISPs that offer asymmetric services should reevalu[1]ate their plans for upstream capacity, or risk becoming less competitive. The implications for policymakers are at least as important. When upstream is poor, some of the Internet uses that should be priorities for policymakers are especially impaired. As too many students and parents learned the hard way during the pandemic, upstream capacity is often required for effective distance learning. It is also critical for many tele[1]health applications. For example, the pandemic forced policymakers and insurance companies to allow and pay for mental health services delivered over the Internet. As a result, some rural areas that have been chronically underserved by mental health providers for decades could finally access these services, but effective interactions with a psychologist often require enough upstream capacity for two-way video. Policymakers can help. The FCC defines a service as “broadband” if the downstream is at least 25 Mb/s and the upstream is at least 3 Mb/s. The majority of households that contain people working from home are far better off with a service that is 20 Mb/s down and 20 Mb/s up than a service that is 100 Mb/s down and 3 Mb/s up, but only the latter would meet the FCC’s current definition of broadband. As a result, a company building out infrastruc[1]ture that can offer the service with just 3 Mb/s up is far more likely to obtain government subsidies. If people continue to work from home in significant numbers, as seems likely, the FCC should reduce the down/up ratio in its broadband definition from the current value of 8 to 1. The focus on downstream at the expense of upstream is even more apparent in how Internet services are marketed, especially from ISPs that offer asymmetric services, such as cable companies. If the largest cable pro[1]viders (Comcast, Charter, and Cox) put any information whatsoever about upstream data rates on their websites, we could not find it. Moreover, the customer service representative we spoke to on the phone was happy to tell us the downstream rate of each Internet service his company offered, but was similarly unable to provide any information about upstream. This lack of information has two unfortunate consequences. First, many consumers will unknowingly choose a service that is inferior for their pur[1]poses, even when that inferior service costs more. Second, ISPs have far less incentive to improve their upstream capabilities, because doing so will do little to lure customers away from competitors. Competition drives quality improvement, but only when customers know what they are buying. The FCC could solve this problem simply by changing transparency rules to require ISPs to provide meaningful information about upstream capabilities.

 

Mayo’s video visits up 5000 percent but how does that impact Rochester’s local economy?

The Post Bulletin reports

“We’re currently touching, caring for more patients on a given day now than they were pre-pandemic when you add in telemedicine activities, plus the patients coming on site for care here,” said Dr. Steve Ommen, a cardiologist and the medical director for experience products for Mayo Clinic’s Center for Digital Health.

Video visits skyrocketed more than 5,000% from 278 visits in February 2020 to 16,532 in December at Mayo Clinic-Rochester. Phone telemedicine visits also soared from 169 to 7,590 in the same timeframe, peaking at 24,670 visits in April 2020.

A looming question remains: How will this affect Rochester’s economy when much of the downtown and the largest private-public economic partnership in state history has been built with the presumption that many of Mayo’s patients will be visiting the city in person?

Sounds like the local economic developers aren’t too worried…

Holly Masek, executive director of the Rochester Downtown Alliance, said her team hasn’t specifically studied how telehealth use could affect the downtown. The general consensus is that there are enough patients traveling to Rochester for extended stays and more specialized care that businesses will not see a significant decrease in income because of telemedicine use.

There are pluses and minuses with remote working too…

Fewer Mayo Clinic employees are working downtown than before the pandemic, though telemedicine certainly can’t be pinpointed as the sole cause of this shift.

“Approximately 2,900 staff who were previously based in downtown Rochester will now work off campus a majority of the time,” Mayo Clinic spokeswoman Ginger Plumbo said to the Post Bulletin’s Jeff Kiger in early July. “This number evolved as Mayo Clinic continued to assess the workforce beyond the initial group of non-clinical administrative staff.”

The number went up from the 1,500 figure Mayo Clinic reported in October 2020.

It looks like the Mayo, more than the city, will need to look at the impact…

Preliminary studies from other healthcare institutions across the country provide a picture into how telemedicine use affects revenue. An April 2021 study by the Department of Orthopaedics at the University of Pennsylvania found that the adoption of telemedicine services resulted in just a -.8% hit to the department’s revenue.

“Given that the nation’s health systems are operating on thin margins amid rising payment and cost pressures, the findings of our study underscore the need for thoughtful examination to ensure telemedicine is used and supported effectively and sustainably,” read the study.

Legislative changes makes it easier to offer and afford telehealth…

Legislation passed in June 2021 as part of the Health and Human Services bill made these changes part of law, not just part of the emergency powers declaration.

For Mayo Clinic campuses in Arizona and Florida, the number of patients receiving care via telemedicine may differ. Arizona recently passed similar protections to Minnesota, while Florida rolled back telehealth regulations passed during the pandemic.

Even if Mayo Clinic’s bottom line isn’t greatly affected by telemedicine use, the patient’s pocketbook may be.

A 2014 study found that the average estimated cost of a telehealth visit is $40 to $50 compared to average cost of $136 to $175 for in-person acute care.

Minnesota legislation regulates the cost of telemedicine services to not surpass what the in-person cost would be.

Kandiyohi County to focus federal funding (ARP) on broadband

West Central Tribune reports

he main focus of the EDC committee is the Federated Telephone fiber broadband project for Dovre, Mamre, St. Johns and Arctander townships. So far, about 681 properties could receive high-speed broadband through fiber if the project is completed.

“This is good news for the people in this area,” Schmoll said.

The project is estimated to cost around $9.7 million and funding is coming from a variety of sources. Federated is funding 25% of the project, and each individual property being hooked up to the new service will have to pay around $1,246, based on current cost projections.

The county has already approved two different funding requests for the project. The first was a $25,000 grant, available to any township in the county expanding broadband access. The second pot of money was $1.3 million from the county’s American Rescue Plan allocation.

More details…

The Kandiyohi County Board of Commissioners has already decided to focus most of the county’s share of the federal funding to broadband, bringing a big lift to the work being done by the Kandiyohi County and City of Willmar Economic Development Commission broadband committee.

“They are giving us the opportunities to get the funds we need to make these projects possible,” said Connie Schmoll, broadband planner, at Thursday’s meeting of the EDC Joint Powers Board.

Large swaths of Kandiyohi County, and the state as a whole, are considered underserved or unserved, meaning properties don’t have access to 100 megabits per second download and 20 mbps upload internet speeds. During the pandemic, it became obvious for many that working and learning from home just wasn’t possible without high-speed, reliable internet.

Schmoll said she heard stories of parents going into the office, when they should not have done so, because they needed to save whatever internet speed they had at home for the children’s distance learning.

Here’s info on their main focus…

The main focus of the EDC committee is the Federated Telephone fiber broadband project for Dovre, Mamre, St. Johns and Arctander townships. So far, about 681 properties could receive high-speed broadband through fiber if the project is completed.

“This is good news for the people in this area,” Schmoll said.

The project is estimated to cost around $9.7 million and funding is coming from a variety of sources. Federated is funding 25% of the project, and each individual property being hooked up to the new service will have to pay around $1,246, based on current cost projections.

The county has already approved two different funding requests for the project. The first was a $25,000 grant, available to any township in the county expanding broadband access. The second pot of money was $1.3 million from the county’s American Rescue Plan allocation.

And a few smaller projects…

In addition to the Federated projects, the committee is looking at other projects across the county. At the July 20 meeting of the Kandiyohi County Board, the commissioners approved sending $35,000 in American Rescue Plan funds to a Charter project in the 141st Avenue Northeast area in New London Township. A small project, it would bring services to 37 unserved homes in the area.

A $1 million project, developed by Arvig, could hook up 510 premises in Prinsburg to high-speed internet. Potential funding sources for that project include American Rescue Plan money from both the county and city of Prinsburg, along with $450,000 from Arvig and another $175,000 from a mix of the school, city and residents.

Telemedicine gains momentum during pandemic and policy changes will keep it going

The Pine Journal reports…

Behavioral and mental health treatment was ahead of other specialties in terms of telemedicine use before the pandemic, but patients have still increasingly turned to those services over the past year.

One study found that telemedical care for mental health or substance abuse disorders increased from 1% of visits before the pandemic to 41% in October 2020.

For most people providing and receiving medical care, the escalated adoption of telemedicine is one of the silver linings amid the devastation of the pandemic. The funds funneled into the technology reflect its increased use. Investment in telehealth technologies in the first half of 2021 was greater than all of 2020, according to an analysis from management consulting firm McKinsey & Company.

While the benefits of telemedicine have been especially appreciated among people who live with physical disability or mental illness, telehealth has also created new barriers for users during a time when medical support was vital.

Telehealth was an important tool…

A NAMI survey found that telehealth visits provided connection in a time when people were starved for it, especially while grappling with mental illness.

“Great to be able to connect with services right from my home. Being able to continue to be in visual connection with my therapist during the most isolated days/weeks of this pandemic was crucial. Nice to see people without masks on!” one respondent wrote.

Several respondents stated that they appreciated the relief of not having to figure out transportation for in-person appointments. Others wrote that they thought it was the safest option for themselves and their families during the pandemic, and it allowed them to stay in a comfortable environment on days they weren’t feeling well.

Unfortunately access to technology was a barrier to some…

“The elderly and kids are the ones who probably lost the most ground in terms of the pandemic and having to move to telehealth,” Abderholden said.

survey conducted by the Minnesota Department of Health also found that these were the groups most affected by barriers with technology.

Although many communities found some solutions…

The SEMCIL [Southeastern Minnesota Center for Independent Living] team offered a repository of 20 iPads and 50 Chromebooks to those in need during the pandemic, fueled largely by CARES Act dollars.

But access wasn’t the only issue…

Older patients seeking treatment for mental illness often encountered technological issues, sometimes only accessing their telehealth services after a provider walked them through how to download the software. Some users stuck with audio-only services, a lifeline for those living in areas with poor internet access.

Even for technology savants, telehealth posed a different problem: screen-time burnout.

School-age children who spent all day in front of their computers engaging in remote schooling would often not feel like diving into emotional issues in the same setting.

“The technology worked fine, but my child was burnt out on doing everything via video and started ending the sessions early. I’m not sure how to make the engagement better though,” wrote one respondent to the NAMI survey.

There were also privacy concerns for people who shared spaces with family members and couldn’t find a discreet area to candidly express their struggles with a mental health professional. Bastin found herself moderating what she said and when, even as she logged into her therapy sessions in the privacy of her room, because she worried family members might hear through the walls.

Regulations have been changed to make telemedicine easier now and in the future…

For years, advocates have tried to loosen restrictions surrounding telemedicine access. When the pandemic prompted widespread use of telehealth services, legislative changes finally followed.

The location where patients are eligible to receive telehealth services broadened in spring 2020 under emergency power authorization, enabling in-home care, and not solely in-hospital or clinic care. A second change allowed for audio-only care, a shift from previous regulations that restricted telehealth visits to video.

Legislation passed in June 2021 as part of the Health and Human Services bill made these changes part of law, not just part of the emergency powers declaration. The coverage of audio-only services is still in question due to concerns regarding quality of care, Renner said, but it is protected for at least the next two years.