Telecommunications: FCC's Performance Management Weaknesses Could Jeopardize Proposed Reforms of the Rural Health Care Program
GAO-11-27
Published: Nov 17, 2010. Publicly Released: Dec 17, 2010.
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Highlights
Telemedicine offers a way to improve health care access for patients in rural areas. The Federal Communications Commission's (FCC) Rural Health Care Program, established in 1997, provides discounts on rural health care providers' telecommunications and information services (primary program) and funds broadband infrastructure and services (pilot program). GAO was asked to review (1) how FCC has managed the primary program to meet the needs of rural health care providers, and how well the program has addressed those needs; (2) how FCC's design and implementation of the pilot program affected participants; and (3) FCC's performance goals and measures for both the primary program and the pilot program, and how these goals compare with the key characteristics of successful performance goals and measures. GAO reviewed program documents and data, interviewed program staff and relevant stakeholders, and surveyed all 61 pilot program participants with recent participation in the program.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Federal Communications Commission | To improve its performance management of the Rural Health Care Program, the Chairman of the FCC should conduct an assessment of the current telecommunications needs of rural health care providers. If FCC does develop any new rural health care programs under the Universal Service Fund--such as the proposed Health Care Broadband Access Fund and the Health Care Broadband Infrastructure Fund--this step should be taken before implementing any new programs or starting any new data collection efforts. | In 2010, we reported that the Federal Communications Commission (FCC) had not conducted an assessment of the telecommunications needs of rural health care providers as it managed the primary Rural Health Care Program, which limited FCC's ability to determine how well the program was addressing those needs. Participation in the primary program had increased, and some rural health care providers reported that they were dependent on the support received from the program. Although FCC had been successful in disbursing over 86 percent of all committed funds, FCC had disbursed over the 12 years of the primary program's operation only $327 million -- less than the funding cap for a single year... of program operation -- to rural health care providers to assist them in purchasing telecommunications and information services. At the time of our audit, FCC was proposing to replace portions of the primary program with a new broadband services program. However, without a needs assessment, FCC could neither determine how well the current program was targeting the needs or rural health care providers nor ensure that a new program would target needs any better. Therefore, we recommended that FCC conduct an assessment of the current telecommunications needs of rural health care providers. In response, in December 2012, FCC adopted a Report and Order for the Rural Health Care Program that included an "Assessment of Broadband Needs of Health Care Providers." FCC's needs assessment included consideration of various bandwidth-intensive telemedicine applications and was based upon information gathered through FCC's programs, outreach meetings with health care organizations and government entities, and information in FCC's record and from public sources. As a result of undertaking a needs assessment, FCC has information to be able to manage the Rural Health Care program in a more proactive fashion, as it can better determine which services the program should support, understand what proper utilization of the program by health care providers should look like, and ensure that programmatic changes are achieving the intended results.
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| Federal Communications Commission | To improve its performance management of the Rural Health Care Program, the Chairman of the FCC should consult with Universal Service Administrative Company (USAC), other federal agencies that serve rural health care providers (or with expertise related to telemedicine), and associations representing rural health care providers to incorporate their knowledge and experience into improving current and future programs. If FCC does develop any new rural health care programs under the Universal Service Fund--such as the proposed Health Care Broadband Access Fund and the Health Care Broadband Infrastructure Fund--this step should be taken before implementing any new programs or starting any new data collection efforts. | In 2010, we reported that the Federal Communications Commission (FCC) missed multiple opportunities to collaborate with the Universal Service Administrative Company (USAC) (the third party administrator of the Rural Health Care Program), federal agencies, and other knowledgeable stakeholders when FCC designed its Rural Health Care Pilot Program. These stakeholders could have provided useful insights into FCC's design of the pilot program. We had reported in previous work on the importance of involving stakeholders when designing, implementing, and evaluating programs. Such consultations could have helped FCC better identify potential pitfalls in program design as well as meaningful...
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| Federal Communications Commission | To improve its performance management of the Rural Health Care Program, the Chairman of the FCC should develop effective goals, and performance measures linked to those goals, for all current and future programs. If FCC does develop any new rural health care programs under the Universal Service Fund--such as the proposed Health Care Broadband Access Fund and the Health Care Broadband Infrastructure Fund--this step should be taken before implementing any new programs or starting any new data collection efforts. | In 2010, we reported that the Federal Communications Commission (FCC) had not developed specific performance goals for the Rural Health Care Program and had developed ineffective performance measures. Previously, we reported that results-oriented organizations set performance goals to clearly define desired outcomes. However, FCC had been operating the Rural Health Care Program under broad, overarching goals, including the statutory goal of ensuring that rural health care providers receive telecommunications services at rates comparable to the same services in urban areas. While FCC had established some performance measures for the program, those measures fell short when compared with...
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| Federal Communications Commission | To improve its performance management of the Rural Health Care Program, the Chairman of the FCC should develop and execute a sound performance evaluation plan for the current programs, and develop sound evaluation plans as part of the design of any new programs before implementation begins. If FCC does develop any new rural health care programs under the Universal Service Fund--such as the proposed Health Care Broadband Access Fund and the Health Care Broadband Infrastructure Fund--this step should be taken before implementing any new programs or starting any new data collection efforts. | In 2010, we reported that FCC had not formally evaluated the performance of the primary Rural Health Care Program to determine whether it was meeting the needs of rural health care providers. At the time, FCC stated that it intended to evaluate its rural health care pilot program after its completion, but we found that it was unclear if FCC had effective evaluation tools for conducting a pilot program evaluation, such as an effective evaluation plan or an effective progress reporting mechanism. We concluded that if FCC did not institute better performance management tools--including planning and conducting effective program evaluations--the agency's management weaknesses would likely...
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| Federal Communications Commission | To improve its performance management of the Rural Health Care Program, the Chairman of the FCC should, for any new program, ensure that FCC's request for applications to the program clearly (1) articulates all criteria for participating in the program and any weighting of that criteria, (2) details the program's rules and procedures, (3) outlines the program's performance goals and measures, and (4) explains how participants' progress will be evaluated. If FCC does develop any new rural health care programs under the Universal Service Fund--such as the proposed Health Care Broadband Access Fund and the Health Care Broadband Infrastructure Fund--this step should be taken before implementing any new programs or starting any new data collection efforts. |
In February 2014, FCC announced the deferral of its Skilled Nursing Facility pilot program under its Rural Healthcare program. The Commission had set aside $50 million for the proposed Skilled Nursing Facility pilot program. FCC deferred the implementation of the pilot program until it determines whether some of the funds set aside for that program should be used instead to conduct consumer-oriented rural broadband experiments intended to improve patient access to health care, noting a growing demand for telemedicine and remote monitoring.
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Access to health careBroadbandHealth care reformInformation accessInformation technologyPerformance managementPerformance measuresProgram managementRegional planningRural healthTelecommunicationsTelemedicinePilot programsProgram implementationRural areas