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VA Wants its Doctors to Treat Veterans Anywhere With Telehealth

VA Secretary David Shulkin has unveiled a plan to give VA doctors the authority to treat veterans no matter where they're located through a telemedicine platform.

Source: ThinkStock

By Eric Wicklund

- Federal officials have unveiled a plan to give VA doctors the authority to treat veterans via telemedicine no matter where those veterans are located.

In a ceremony attended by President Donald Trump this past week, Department of Veterans Affairs Secretary David Shulkin announced the “Anywhere to Anywhere VA Healthcare Initiative,” which would allow VA doctors to connect with veterans in any state through a telehealth link.

Shulkin earned praise from, among others, the American Telemedicine Association – which has scheduled him as a keynote speaker at its fall conference in the nation’s capital – and Sen. Joni Ernst (R-Iowa), whose Veterans E-Health & Telemedicine Support (VETS) Act of 2017 seeks to give VA doctors that same authority.

Shulkin said he wants to free up the VA to hire more healthcare providers in urban areas, where they’re in abundance, to be able to treat veterans living in rural and underserved areas.

But he may face opposition from groups like the American Medical Association, which has opposed the VETS Act and argued that such efforts rob state medical boards of the right to govern and police their own doctors.

READ MORE: VA Expands Telehealth Access for Veterans

While the exact wording of the Anywhere to Anywhere VA Healthcare Initiative hasn’t been published yet, Politico reports Shulkin has long sought to give VA doctors this freedom and has sought advice from the Justice Department on how to implement such a directive.

A similar dispute in last year’s Defense Department budget deliberations ended with the government ceding the argument to the states.

During Congressional deliberation last September on the National Defense Authorization Act for FY 2017, the AMA and American Academy of Family Physicians lobbied against a telehealth benefit for the TRICARE program that would have designated the originating location for certain telehealth services to be the physician’s location, instead of the patient’s location. They argued the legislation would enable physicians treating military personnel and veterans to skip state licensing laws when treating patients via telehealth.

In a Sept. 1 letter to Congressional leaders, AAFP Board Chairman Robert L. Wergin, MD, warned that the Senate version of the bill “portends a troubling scenario under which state licensing boards will lack the authority to discipline physicians who are practicing medicine within that state’s borders.”

“While this language would indeed ease barriers that hinder the free flow of telehealth services, it also would undermine the existing system of medical licensure, under which each state governs the practice of medicine within its borders,” Wergin wrote. “Allowing physicians with a single license to treat TRICARE beneficiaries in any state via telemedicine would create episodes of medical care that the state in which the patient resides cannot readily regulate, if at all.”

READ MORE: Telehealth Reimbursement and Its Interstate Licensure Problem

Legislators stripped the controversial language out of the bill prior to its passage in December.

When the VETS Act was first introduced in 2015, the Federation of State Medical Boards – which recently saw its Interstate Medical Licensure Compact go live – argued that the bill bypasses the rights of state medical boards to regulate physicians. The FSMB said healthcare providers should be licensed in each state in which their patients are located, so as to protect accountability and oversight.

The National Council of State Boards of Nursing, which recently enacted its own licensure compact for nurses, also argued against the VETS Act of 2015.

“While NCSBN supports license portability for VA-employed providers, we do not support expanding VA state licensure exemptions to personal services contractors, particularly those who would provide treatment via telehealth, as was proposed in the Veterans eHealth and Telemedicine Support (VETS) Act of 2015,” David C. Benton, the NCBSN’s chief executive officer, said in a recent letter to Shulkin.

“If an adverse event takes place that harms a patient, personal services contractors fall under the jurisdiction of the state licensing boards,” Benton wrote. “For this reason, providers in the private sector must be licensed in the state where the patient is located. Extending the exemption to personal services contractors would remove state licensing boards’ jurisdictional authority over some providers delivering care to veterans in their state, and, ultimately constrain a board’s ability to fulfill their duty to protect those that have served their country.”

READ MORE: Survey: Telemedicine Tops the List of Medical Board Priorities

Benton praised the latest version of the VETS Act, which he said was modified after conversations with the NCBSN, and even urged Shulkin to use it as a model for the VA’s efforts to update its telehealth regulations.

Ernst and Hirono also issued a statement lauding Shulkin’s efforts.

“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,” Ernst, a National Guard veteran, said“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.”

“Today’s announcement is a positive step forward to allow Hawaii veterans to access healthcare services regardless of where they live,” added Hirono. “I will continue to push for the passage of the VETS Act to ensure that Secretary Shulkin’s announcement can be strengthened with full legislative authority to help veterans across the country.”

The ATA also praised Shulkin, while calling on President Trump to end the confusing hierarchy of state and federal licensing regulations.

“We applaud Dr. Shulkin for demonstrating the value of telehealth today at the White House.” Gary Capistrant, the ATA’s Chief Policy Officer, said in a press release. “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.” 

Along with the telehealth initiative, Shulkin made two mHealth announcements designed to improve veterans access to healthcare.

He announced that the VA Video Connect app, which is now used by more than 300 VA providers at 67 hospitals and affiliated clinics, will be rolled out nationwide over the next year. VA Video Connect provides a secure and web-enabled video link for veterans seeking VA services from their smartphones, tablets, laptops or PCs.

Second, Shulkin announced the nationwide roll-out of Veteran Appointment Request (VAR) app, which allows veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities.

“What we’re really doing is, we’re removing regulations that have prevented us from doing this,” he said in a press release. “We’re removing geography as a barrier so that we can speed up access to Veterans and really honor our commitment to them.”

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