- A bill that would allow Veterans Affairs physicians to us treat veterans via telehealth no matter where they live has passed muster with the House Committee on Veterans Affairs.
The Veterans E-Health & Telemedicine Support (VETS) Act of 2017 (H.R. 2123), submitted in the House last April by U.S. Reps. Julia Brownley (D-Calif.) and Glenn Thompson (R-Pa.), sailed through a markup session on Thursday with little opposition. The bill now moves on to the full House.
“I think this is going to expand telehealth within the VA and I think it will improve upon our healthcare delivery to our veterans across the nation,” Brownley told the committee during Thursday’s hearing.
A companion bill, submitted by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii), S. 925, still awaits action in the Senate. Ernst, a veteran, and Hirono had first submitted the legislation in 2015.
While the VETS Act has received strong support, chances of its passage into law are still slim, owing to a reluctance in Congress to pass any new legislation related to telehealth or telemedicine. Skopos Labs, a New York-based software developer that analyzes Congressional legislation, gives the bill a 12 percent chance of success, according to GovTrack.
“Telemedicine is not at the top of the list for any lawmaker,” Krista Drobac, a partner at Sirona Strategies, a Washington, D.C.-based healthcare lobbying firm, pointed out during a panel discussion at last week’s Connected Health Conference in Boston.
The VETS Act is part of a two-pronged effort to boost telehealth and telemedicine services to veterans, especially those in rural areas, where access to care may be difficult.
According to the VA, some 702,000 veterans (12 percent of the veteran populations in the US) received healthcare services via telehealth in FY 2016, with 45 percent of those located in rural areas. In addition, almost 90 percent of veterans receiving care through telehealth expressed satisfaction in the online platform, which was responsible for a 31 percent decrease in VA hospital admissions and a 59 percent decrease in VA bed days of care.
The legislation would give Congressional backing to a component of VA Secretary David Shulkin’s “Anywhere to Anywhere VA Health Care” program, unveiled in September, that would give VA doctors the authority to treat veterans no matter where they’re located.
“In an effort to furnish care to all beneficiaries and use its resources most efficiently, VA needs to operate its telehealth program with healthcare providers who will provide services via telehealth to beneficiaries in states in which they are not licensed, registered, certified, or located, or where they are not authorized to furnish care using telehealth,” the proposed order states. “Currently, doing so may jeopardize these providers’ credentials, including fines and imprisonment for unauthorized practice of medicine, because of conflicts between VA’s need to provide telehealth across the VA system and some states’ laws or licensure, registration, certification, or other requirements that restrict or limit the practice of telehealth. A number of states have already enacted legislation or regulations that restrict the practice of interstate telehealth.”
As a result, VA officials say, many VA centers aren’t expanding their telehealth and telemedicine programs to non-federal locations, such as the patient’s home or the doctor’s home. And VA doctors are reluctant to take on telehealth for fear of running into conflicts with state laws.
A point of contention in both efforts is that VA doctors would be able to bypass state licensure laws and telehealth regulations to treat veterans in those states.
Among the critics is the Medical Board of California.
In an Oct. 30 letter to Shulkin, the board said the VA secretary’s proposed rule “would undermine California’s ability to protect healthcare consumers, as the board will have no ability to discipline VA providers that are licensed in another state and providing telehealth outside of a VA facility in California, as they do not hold a license to practice in California.”
“Although the board believes that telehealth is a useful tool that can be used to provide appropriate service to patients in California, the board believes that it is very important for physicians treating patients in California to be licensed in California,” the letter concluded.
The legislation has received support from a broad range of healthcare and telehealth groups, many of which have in the past supported states’ rights to license and regulate doctors.
Among those supporting the VETS Act are the American Telemedicine Association, American Medical Informatics Assocation, Federal Trade Commission, Health IT Now, the American Academy of Family Physicians, the College of Healthcare Information Management Executives (CHIME), Teladoc, Oracle, the American Psychological Association, the Brain Injury Association of America, the National Association of Social Workers and the University of Pittsburgh Center for Military Medicine Research.
“This proposed rule will be instrumental in breaking down geographic barriers that, for too long, have prevented our nation’s heroes from accessing the care they need where they need it,” Health IT Now Executive Director Joel White said in a Sept. 29 blog supporting both Shulkin’s program and the Congressional bills. “By allowing VA telehealth providers to more easily treat patients across state lines, we can ensure that recent advances in technology-enabled care reach the most deserved among us and spur better outcomes for the 20 million veterans in the VA system today.”
The AAFP, meanwhile, offered cautionary support for the VETS Act and Shulkin’s proposed order.
“Since this proposal is limited to a special situation within the VA and to support veterans’ access to health services, the AAFP offers qualified support for this proposed expansion of clinically validated telehealth services,” AAFP Board Chairman John Meigs Jr., MD, said in on Oct. 31 letter.
“However, the AAFP still strongly supports state-based licensure and regulation of physicians and other healthcare providers as well as the states’ ability to regulate the practice of telehealth in their state,” he added. “As noted within the proposed rule, the VA only has legal authority to hire healthcare providers who are licensed, registered, or certified in a state. To continue practicing in the VA, providers must maintain those credentials in accordance with their healthcare specialty.”
“While the AAFP has historically opposed federal or legislative actions superseding state restrictions on licensure, and instead support FSMB licensure compact participation, we nevertheless believe that in this narrow case of the VA, federal preemption of state licensure could possibly serve the public interest and is perhaps not too inappropriate,” Meigs concluded. “The AAFP continues to support physician licensure at the state level, and believes that the VA’s unique nature as a unified national health-care system that straddles state boundaries, and its important role of treating the nation’s veterans, justifies a very limited exception in this case.”