As part of the new “Anywhere to Anywhere VA Health Care Initiative,” Department of Veterans Affairs (VA) providers will soon be able to provide telehealth services across state lines regardless of the state’s licensing rules. The goal is to create a national telemedicine network that can reach veterans in their homes or at locations outside VA hospitals. Effective June 11, the change is expected to increase access to care by making more clinicians available for appointments for patients in rural, remote, or medically underserved areas. Currently, in order to treat a patient located in another state via telemedicine, healthcare providers are required to be licensed in that state. This will still hold true for private-sector practitioners and contractors; the new ruling only applies to VA employees, eliminating the complex licensing and insurance requirements typically associated with interstate telemedicine.
With support from such organizations as the American Telemedicine Association, American Association of Family Physicians, American Medical Informatics Association, College of Healthcare Information Management Executives, and others, the proposed amendment garnered even more support from the public on behalf of patients during last fall’s 30-day comment period; some commenters expressed belief that the rule would improve convenience and access to health care, clinical outcomes, and quality of care for a large variety of conditions. Others expect streamlined care and more modern, family-centered health care. The Federal Trade Commission (FTC) added that the amendment would enhance competition, allow the VA to compete more effectively in recruiting qualified providers, and spur innovation among other health care providers, thus promoting competition and improving overall access to care.
Many commenters also feel that the rule will benefit the VA and its providers by increasing cost effectiveness, reducing appointment times and no-show rates, and protecting health care providers. Also expected are decreased hospital admissions and emergency room visits, as well as higher revenues for local laboratories and pharmacies. Some individuals expressed relief that the barriers blocking interstate telemedicine are no longer such a hindrance to the industry.
However, valid concerns were raised as well: Telehealth may not be an appropriate method of health care delivery for all beneficiaries, and due to the nature of interstate telemedicine, providers may rely too heavily on verbal communication rather than observed symptoms such as tremors, manic behaviors, or bruises. Furthermore, if the physician does not have access to the patient’s complete medical history, the continuity of health care could be disrupted to the detriment of the patient. In response, the VA noted that the rule merely offers the option of using telemedicine and does not require service delivery through telemedicine; instead, it empowers providers and patients to determine when telemedicine is appropriate.
Other skeptics pointed out the lack of infrastructure; some beneficiaries lack the technology or bandwidth to handle a telemedicine connection. The VA acknowledged this issue as an ongoing challenge that is under consideration overall but is beyond the scope of this rule.
Finally, some questioned whether the VA has the authority to override the state licensure requirements. As explained by the VA, agencies are allowed to preempt state law if exercising the state authority conflicts with exercising the federal authority under a federal statute; in this case, a state rule that limits telemedicine directly conflicts with the VA’s authority to establish qualifications for providers and regulate their professional activities, i.e., practice telemedicine anywhere.
In 2017, only 12 percent of U.S. veterans used telemedicine, according to figures announced at the ATA’s annual conference earlier this month in Chicago. Of these, only 1 percent accessed the technology while at home. With the new rule in place, it will be interesting to see how quickly these numbers rise.
To read the text of the amendment, visit the Federal Register of the U.S. Government here.