- Legislators on both sides of Capitol Hill have reintroduced a bill that would ease restriction on telehealth and mHealth for veterans, especially those in rural areas.
The Veterans E-Health & Telemedicine Support (VETS) Act of 2017 has been reintroduced by Sens. Joni Ernst (R-Iowa) and Mazie Hirono (D-Hawaii). Companion legislation in the House is being submitted by Reps. Julia Brownley (D-Calif.) and Glenn Thompson (R-Pa.).
“Iowa is home to more than 200,000 veterans, many of whom reside in more rural areas, distant from Iowa’s VA facilities,” Ernst, a National Guard veteran who first submitted the bill in 2015, said in a press release issued after she resubmitted the bill this week. “Telehealth offers another way in which we can provide veterans the care they need, including critical, and potentially lifesaving mental healthcare. The VETS Act will ensure that veterans can receive the timely and quality care they deserve from the comfort of their own homes.”
Under current law, healthcare providers can use telemedicine and mHealth to treat veterans, but when care is delivered across state lines, both the doctor and the patient have to be in federal facilities. The VETS Act would remove that barrier, enabling veterans to access telehealth in their homes or other locations.
“Hawaii veterans shouldn’t have to fly to Oahu, or even different states, to seek the medical care they have earned,” Hirono said in the press release. “The VETS Act builds on a VA telemedicine program that is proven to work, and removes barriers to accessing care particularly for veterans in rural areas like Hawaii’s neighbor Islands.”
The idea of restricting where patients or providers can access or deliver telemedicine isn’t new. The Centers for Medicare & Medicaid Services has strict limits on so-called originating sites in its Medicare reimbursement rules, limiting payments to strictly-refined rural parts of the country. Some states have also tried to regulate access by requiring patients to be in healthcare facilities, and in some cases the laws require that a clinician be present as a telepresenter.
According to the Department of Veterans’ Affairs, the VA oversaw 2.14 million telemedicine or telehealth visits in 2015, connecting more than 677.000 veterans with healthcare providers.
At last year’s American Telemedicine Association conference in Minneapolis, then-VA Undersecretary for Health David J. Shulkin said more than 12 percent of the nation’s 5.6 million veterans access healthcare through digital channels. That has helped to reduce the number of days that veterans spend in a VA hospital by some 56 percent and spawned more than 45 specialty telehealth platforms.
Shulkin said the VA is bolstering its online presence, with some 32 mHealth apps now available and an enhanced patent portal accepting 1.7 secure messages from veterans to their providers in the past year, all designed to “encourage self-management among veterans.”
The VA has also launched a network of Mental Health Telehealth Resource Centers, designed to tackle a growing population of veterans dealing with PTSD, chronic depression and bipolar disorder, among other issues. On the horizon are a kiosk program and a text messaging program for medication management.
Stung by coverage of access issues at VA hospitals over the past two years, he said the department has launched what he called a “Declaration of Access.” And that effort, he said, includes a “significant enhancement of our telehealth capabilities.”
But while the VA is beefing up its resources, legislators say veterans – especially those in rural areas or with access issues – need to be able to reach out to healthcare providers when they need help.
“The VA has seen tremendous growth and interest in telehealth,” Brownley, one of two House sponsors of the bill, told MilitaryTimes.com. “And we should continue to find new ways to connect veterans with the providers that they need, no matter their physical location.”
The bill is part of a recent spate of re-introduced legislation targeting telemedicine and mHealth, including the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, Hallways to Health Act, the Furthering Access to Stroke Telemedicine (FAST) Act the Telehealth Innovation and Improvement Act.
The bill also calls on the Secretary of Veterans Affairs to complete a study within a year on the use of telemedicine by the Department of Veterans Affairs, and to submit that study to the Committee on Veteran’s Affairs in both the Senate and House.
According to Ernst, the VETS Act is endorsed by the American Legion, American Telemedicine Association, Coalition for Health IT Now and Veterans of Foreign Wars.
Not everyone is on board with the legislation. When it 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.
That concern also surfaced in debate over this year’s Defense spending budget.
Prior to passage last December, the Senate version of The National Defense Authorization Act for FY 2017 mandated that the originating site for telehealth services – defined for such issues as licensure, reimbursement and liability – would be the physician’s location, rather than that of the patient.
Groups including the American Academy of Family Physicians and the American Medical Association objected, saying the legislation would enable physicians treating military personnel and veterans to skip state licensing laws when treating patients via telehealth.
The language was scrubbed out of the final legislation.