The Department of Veterans Affairs serves more than nine million veterans a year at 170 medical centers and over a thousand outpatient locations. Provider shortages and delays in treatment have been well-publicized over the last several years. In an attempt to shorten wait times and increase access to care for patients who are entitled to the care, the Department of Veterans Affairs amended rules for providers and telehealth as of June 11, 2018. Through telemedicine, Veterans Affairs providers can now offer services to patients regardless of the state where the patient resides, and the services can extend to the home site as well. This is a monumental change that will open up access to care for important and often life-saving services.
Access to Many Specialties
Now, providers in many different areas can offer telehealth solutions to patients who may be located anywhere in the country. The provider does not have to be licensed in multiple locations to offer these services as long as the patient is under the care of Veterans Affairs. According to the rule as published by The Office of the Federal Register,
“Telehealth enhances VA’s capacity to deliver essential and critical health care services to beneficiaries located in areas where certain health care providers may be unavailable or to beneficiaries who may be unable to travel to the nearest VA medical facility for care because of their medical conditions.”
This is a large divergence from the previous policy. Before, providers were required to follow state laws for licensing, which often limit the provider to offering telemedicine services only to patients who reside in states where the provider has a license.
While the most frequently discussed implementation of these telemedicine programs is in mental health, primary care and medical specialists can also look forward to using technology to deliver care to patients who may be remote or located in rural areas. As long as the care is medically necessary and within the standard of treatment, all Veterans Affairs beneficiaries qualify.
The rule further states:
“By providing health care services by telehealth from one State to a beneficiary located in another State or within the same State, whether that beneficiary is located at a VA medical facility or in his or her own home, VA can use its limited health care resources most cost efficiently.”
Why Does It Matter?
With considerable provider shortages and often long wait times at VA facilities across the country, telehealth provides an alternative while still offering quality medical care to our nation’s veterans. Up until the rule change, VA facilities were required to follow state laws for licensing and practice that limited providers within the system from accessing patients who may be over state lines or located in the home. Facilities that did have the specialists or staff were unable to assist locations that were underserved. The rule change means that “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.”
What Isn’t Allowed?
While providers are now able to practice over state lines, that flexibility does not extend to the prescribing of controlled substance. Prescribing, in many cases, is still subject to state laws and limitations, and providers will not be able to write controlled medications for patients who are located outside of the state unless state law specifies that this is allowed. Some states do not allow prescription of controlled substances via telemedicine at all, while others limit it to specific medications or specialties. The laws vary considerably by state, and the new rule does not provide any variability for access. The rule does not specify how this will be managed by the VA health centers.
Costs and Competition
While the goal of the rule was to extend care to veterans who may otherwise be underserved, the added advantage is the access to more technologies as well as making the VA more attractive to talent. The agency is positioned at the forefront of distant medical delivery, and the flexibility that is afforded by this schedule enables them to hire providers from all corners of the country. They can meet care gaps while expanding the pool of available specialists and strengthening the organization overall.