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Barriers Fall for VA’s Ability to Provide Telehealth Across State Lines

by Sandra Basu

September 13, 2017

By Sandra Basu

WASHINGTON—A new regulation allows VA providers to treat patients via healthcare, regardless of location, leading to plans by the agency to expand its program to provide medical care remotely.

The plans were announced last month by President Donald Trump and VA Secretary David Shulkin, MD, speaking from the White House.

VA Secretary David Shulkin, MD, center, joined President Donald Trump at the White House to make a major announcement on telehealth last month. Official White House. Photo by Shealah Craighead

“This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request—and also in suicide prevention,” Trump said. “It will make a tremendous difference for the veterans in rural locations in particular.”

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Shulkin added that VA will work with the Office of American Innovation and the Justice Department to issue a regulation that “allows our VA providers to provide telehealth services from anywhere in the country to veterans anywhere in the country, whether it’s in their homes or any location.”

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

Until the change in law, rules barred VA providers from providing telehealth services across state lines, unless both the veteran and the doctor are located in federal facilities.

Shulkin said that the change in regulations will mean that the agency will “be able to use VA providers in cities where there are a lot of doctors, and be able to use those doctors to help our veterans in rural areas where there aren’t many healthcare professionals.”

The “VA Video Connect” program will be rolled out to provide those services, he explained, and allows telehealth services to be provided to veterans on their mobile devices or home computers.

A ‘Big Deal’

 “That’s a big deal,” Shulkin emphasized. “Currently, we use VA Video Connect with over 300 VA providers at 67 of our hospitals or clinics across the country.”

VA already has the largest telehealth program in the country, he added, noting that, last year, 700,000 veterans got telehealth services through the VA, and that telehealth services are offered for 50 different specialties.

“It’s really going to expand access for veterans in a way we haven’t done before,” the VA secretary said.

Allowing VA providers to be able to practice telehealth across state lines has already been pushed by some lawmakers via legislation such as the Veterans E-Health and Telemedicine Supports Act, which was revamped and reintroduced in Congress this year after a previous version of the bill met with opposition from some groups.

Co-sponsors of the Senate legislation, Sen. Joni Ernst (R-IA) and Sen. Mazie Hirono (D-HI), praised VA’s announcement to expand telehealth services for veterans.

“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,” Ernst said.

Hirono assured, meanwhile, that she “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.”

Meanwhile, the American Telemedicine Association suggested that the administration should take things even further.

“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,” said ATA Chief Policy Officer Gary Capistrant.

Commenting on amending telehealth regulations before the announcement was made by VA, the National Council of State Boards of Nursing (NCSBN) CEO David Benton wrote in a July 21 letter to the agency that “NCSBN supports extending that same license portability for VA-employed providers who deliver care via telehealth so long as they maintain a valid state license.”

“As these regulations are developed, we would like to stress how important regulatory clarity is for providers and patient safety. It may be necessary for VA to simultaneously update internal adverse event investigative procedures to ensure that they take newly available telehealth services into consideration,” Benton recommended.

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,” the group’s CEO further explained.

The implications of using telehealth across state lines has been controversial and has raised a number of issues in recent years. When the 2017 NDAA was under discussions last year, for example, the American Medical Association and American Academy of Family Physicians opposed a measure in that bill that would have designated the physician’s location as the originating location for certain telehealth services—not the patient’s—for purposes of medical licensure, payment and liability.

AAFP Board Chairman Robert L. Wergin, MD, wrote in a letter last year that the provision “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.”

That language was ultimately taken out of this bill prior to passage.


8 Comments

  • Susan Warner says:

    We would like to set up telehealth in our Region, and need some connection with other centers where this is set up so we can learn and develop our program more efficiently.

  • Susan Warner says:

    We would like to set up telehealth in our Region, and need some connection with other centers where this is set up so we can learn and develop our program more efficiently.

  • scott mcnairy MD says:

    Here in Mpls, MN as an addiction psychiatrist/UMN fellowship training director, I have provided telemed consultation and coverage to CBOC in-state and western WI to specifically address the opioid epidemic with MATx. We have also provided consultation to waivered providers at other VA sites out of state in VISN 23 (and Mayo Clinic) to establish/improve their MATx programs.

    What I have learned is that via telemed we are only as good as the allied professionals at the POC clinics. MATx trained Nursing is essential and makes service delivery possible with follow-up care at least monthly.

    I would like to see more delivery of Alcohol based MATx provided directly by the PCP on-site but based upon a QUERI project in the PACTs here in Mpls. it is still a hard sell (even though far easier for PCP to administer and monitor than Opioid MATx once they gain CONFIDENCE). Telehealth can upgrade PCP skills and practice in addition to our direct services to vets by telemed.

  • Pam Detrick says:

    I believe we are getting closer to changes that actually will benefit the veteran. I am all in. Where do I sign up.

    Pam Detrick, PhD, ARNP, FNP, PMHNP, CAP
    Board Certified Addictions Professional, Family Nurse Practitioner, Psychiatric Nurse Practitioner, Pain Management

    Now work on firing incompetent supervisors and employees!!

  • Olive A Phillips says:

    I am a primary care provider, APRN in the North Little Rock VA at Fort Roots since 2004 and I frequently use tele-monitoring for patients with diabetes and hypertension and have seen a tremendous improvement in the level of patient engagement and outcome measures. We are seeing a remarkable decrease in our blood pressure and blood glucose readings. Our patients are also very satisfied with the ongoing communication and timely feedback from their PACT team. The nurses how monitor these daily data trends are dedicated to upholding the I CARE values of the VA under the engaged leadership of Ms. Joanne Hyett. I see the tremendous potential to decrease costs while improving the patient experiences and outcomes. I am also please to see that there is an increasing body of evidence supporting the effectiveness of tele-monitoring.
    Olive A Phillips APRN PACT 18

  • Pam Detrick says:

    I believe we are getting closer to changes that actually will benefit the veteran. I am all in. Where do I sign up.

    Pam Detrick, PhD, ARNP, FNP, PMHNP, CAP
    Board Certified Addictions Professional, Family Nurse Practitioner, Psychiatric Nurse Practitioner, Pain Management

    Now work on firing incompetent supervisors and employees!!

  • Olive A Phillips says:

    I am a primary care provider, APRN in the North Little Rock VA at Fort Roots since 2004 and I frequently use tele-monitoring for patients with diabetes and hypertension and have seen a tremendous improvement in the level of patient engagement and outcome measures. We are seeing a remarkable decrease in our blood pressure and blood glucose readings. Our patients are also very satisfied with the ongoing communication and timely feedback from their PACT team. The nurses how monitor these daily data trends are dedicated to upholding the I CARE values of the VA under the engaged leadership of Ms. Joanne Hyett. I see the tremendous potential to decrease costs while improving the patient experiences and outcomes. I am also please to see that there is an increasing body of evidence supporting the effectiveness of tele-monitoring.
    Olive A Phillips APRN PACT 18

  • scott mcnairy MD says:

    Here in Mpls, MN as an addiction psychiatrist/UMN fellowship training director, I have provided telemed consultation and coverage to CBOC in-state and western WI to specifically address the opioid epidemic with MATx. We have also provided consultation to waivered providers at other VA sites out of state in VISN 23 (and Mayo Clinic) to establish/improve their MATx programs.

    What I have learned is that via telemed we are only as good as the allied professionals at the POC clinics. MATx trained Nursing is essential and makes service delivery possible with follow-up care at least monthly.

    I would like to see more delivery of Alcohol based MATx provided directly by the PCP on-site but based upon a QUERI project in the PACTs here in Mpls. it is still a hard sell (even though far easier for PCP to administer and monitor than Opioid MATx once they gain CONFIDENCE). Telehealth can upgrade PCP skills and practice in addition to our direct services to vets by telemed.


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