One of the bigger and more interesting RFPs on the street right now is the FCC’s “COVID-19 Telehealth Program,” which has $200 million available for obvious purposes—but grants are being accepted, reviewed, and approved on a first-come, first-served basis (federal RFPs usually have a fixed due date).* Lots of FQHCs are also implementing, or trying to implement, telehealth programs on the fly, since COVID-19 has hit them with a structural double whammy: patients with COVID-19 need to be isolated as much as possible from other patients, and other patients are avoiding health clinics for fear of catching COVID-19. This has had the unexpected side effect of lowering patient volumes at FQHCs, which, like other healthcare providers, have reacted by laying off staff. You’d intuitively think that, during a pandemic, the need for healthcare staff would expand, but that’s not happened outside of NYC intensive care units.
So the FCC program is designed to help FQHCs and other providers move relatively quickly to telehealth, which may help FQHCs achieve a higher patient volume. On Saturday we were working to backcheck a client’s online FCC application, since it’s our standard practice to make sure that applications are as complete and technically accurate as possible before client upload. But when we tried to log into the FCC’s application site, we were hit by a message telling us that the FCC had closed its application portal for maintenance. Is shutting a site down for “maintenance” still necessary in 2020? The error message felt very 2003, and, as you probably know, we’re in the midst of a pandemic, when every day counts. I guess FCC didn’t get the pandemic memo.
Eventually the site came back up, but its closure seems like a metaphor for many of the challenges we, as a society, are collectively facing from bureaucrats during these strangest of times.
The FCC COVID-19 Telehealth grant program is also unusual because it specifically says that applicants can only buy Internet-connected telehealth equipment—meaning blood pressure cuffs or pulse oximeters that automatically relay information to healthcare providers. I’ve seen budgets for how much these devices cost, and they’re crazy expensive, as most medical devices are. But: did you know that something as simple as an Apple Watch can function as a pulse oximeter—except that FDA regulations are blocking this use? This is the same FDA whose regulations stopped independent labs from rolling out virus testing in February. We try not to link outrage stories here, but it’s hard to read “The Infuriating Story of How the Government Stalled Coronavirus Testing” without being justifiably outraged.
Today, pointless FDA regulations are blocking people from using a relatively cheap and widely available device from being deployed in a medical context. Apple.com lists “Series 5” Apple Watches at $399 and they’re shipping today (there’s been a pulse ox shortage). Our FQHC clients already know this, but pulse oxes are useful for determining whether a COVID-19 patient needs to be hospitalized, or needs supplemental oxygen. Most COVID-19 patients can recover on their own without medical intervention, but low blood oxygenation is a key danger metric: a normal blood oxygenation level is around 95 – 100. If a patient’s oxygenation level consistently falls below 90, that patient likely needs advanced care. Most households have a thermometer, but relatively few have pulse oxes. Many COVID-19 patients are suffering from what doctors are calling “silent hypoxia,” in which the patient is essentially suffocating but doesn’t realize they’re suffocating, and pulse ox data can tell the patient whether they need to go in to see their doc or to an ER. It would be relatively easy for Apple to allow Apple Watch users to link their health data with a healthcare provider, and for the healthcare provider go get an alert if a patient’s blood oxygenation level drops below 92 or 90. Cheap solutions exist but the FDA keeps us from implementing them.
* Other federal departments have been funding similar telehealth-related grants programs: for example, the USDA has $40 million available via the “Distance Learning and Telemedicine Grants.” Those grants aren’t due until July 13, however.