- A national telehealth program to connect veterans and healthcare providers no matter where either is located is set to become official.
The Department of Veterans Affairs has posted former Secretary David Shulkin’s ambitious connected care initiative in the Federal Register, finalizing a plan to improve access to healthcare for veterans who have difficulties visiting the VA’s estimated 900 hospitals and clinics around the country. The rule enables VA practitioners to use telehealth to connect with veterans in any state, effectively bypassing state licensure laws.
“This final rulemaking clarifies that VA healthcare providers may exercise their authority to provide health care through the use of telehealth, notwithstanding any State laws, rules, licensure, registration, or certification requirements to the contrary,” the rule, dated May 8, states. “In so doing, VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”
“Preemption is the minimum necessary action for VA to furnish effective telehealth services because it would be impractical for VA to lobby each State to remove any restrictions that impair VA’s ability to furnish telehealth services to beneficiaries and then wait for the State to implement appropriate changes,” the rule continues. “That process would delay the growth of telehealth services in VA, thereby delaying delivery of healthcare to beneficiaries. It would be costly and time-consuming for VA and would not guarantee a successful result.”
VA officials have stressed that the rule doesn’t give VA practitioners any extra liberties, but allows them to treat veterans through telehealth. It also does not apply to physicians involved in the VA Choice program.
The “Anywhere to Anywhere VA Health Care Initiative” was unveiled last fall by Shulkin, whose goal was to create a national telemedicine network that could reach out and help veterans in their homes or at locations other than VA hospitals.
“What we’re really doing is, we’re removing regulations that have prevented us from doing this,” Shulkin said at an event attended by President Donald Trump. “We’re removing geography as a barrier so that we can speed up access to Veterans and really honor our commitment to them.”
The initiative was supported by a wide array of organizations, including the American Telemedicine Association, American Association of Family Physicians, AAFP, American Medical Informatics Association, Federal Trade Commission, 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, the University of Pittsburgh Center for Military Medicine Research and Health IT Now.
“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,” Joel White, the group’s executive director, said in a Sept. 29 blog post. “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.”
It also has broad Congressional support. It was included in The Veterans E-Health & Telemedicine Support (VETS) Act of 2017, passed unanimously in both the House and Senate and awaiting reconciliation and then Trump’s signature.
“The VA’s decision to allow veterans to access care from the comfort of, or closer to, their own homes is necessary to improving quality and timely care for the more than 200,000 veterans in Iowa, particularly those who are disabled or reside in rural communities,” Sen. Joni Ernst (R-Iowa), a National Guard veteran, said last fall. “It is critical that we continue to create opportunities for veterans to receive the best care out there, including potentially life-saving mental healthcare. Improving the VA’s telehealth program is critical, and I am thrilled to see this common-sense measure will be put into action to benefit Iowans and veterans across the country.”
Critics had warned that the program would affect a state’s right to regulate its physicians. The AAFP, for example, has said it supports this specific bill to improve veterans’ access to much-needed healthcare services, though it “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.”
The ATA, meanwhile, said both the VETS Act and Shulkin’s telemedicine program point out the confusing hierarchy of state and federal telemedicine licensing regulations.
“We applaud Dr. Shulkin for demonstrating the value of telehealth today at the White House.” Gary Capistrant, the ATA’s former Chief Policy Officer, said in an Aug. 3, 2017 release following Shulkin’s demonstration of the program in the nation’s capital. “We encourage President Trump to issue an Executive Order to eliminate the state-by-state licensure model for all federal and private-sector health professional employees servicing federal government programs—notably agencies (such as the VA and the Department of Health and Human Services), health benefit programs (such as Medicare and TRICARE), federally-funded health sites (such as community health centers and rural clinics), and during federally-declared emergencies or disasters.”
The program is expected to help an agency that saw only 12 percent of the nation’s veterans – or roughly 727,000 people - use telehealth in 2017, according to figures released at the ATA’s recent conference in Chicago. Of that number, however, only 1 percent used telehealth while they were at home.
The VA has been moving the pieces into place to create this new network once the program is finalized. In January, the agency awarded a $260 million contract to 1Vision LLC, a subsidiary of HMS Technologies, to deliver home-based telehealth solutions to veterans. Following that announcement, AMC Health was selected to deploy its CareConsole virtual care and remote monitoring platform, which will enable veterans to communicate with VA practitioners and transmit mHealth data from Bluetooth-enabled devices in their homes.