One of telehealth’s biggest proponents is The U.S. Department of Veteran Affairs. The benefits to PTSD survivors alone is reason enough for their support. VA already wants to make telehealth part of its daily operations but claims that state licensing laws are still an issue. Current laws dictate that physicians must be licensed in the state they are practicing. This prohibits the ability of a licensed doctor to treat out-of-state patients. Since remote care is still the very essence of telehealth, this poses a serious problem.
Yet, state laws have yet to prevent VA from becoming a national leader in the field. Last year alone, it spent $1.2 billion on telehealth visits. The department has come a long way since 2013, when its telemedicine budget was only $500 million. Currently, it is estimated that 12% of patients enrolled in the Veterans Health Administration received some aspect of treatment remotely.
So far, VA has managed to find ways around restrictions. For example, as long as a doctor has an unrestricted license in one state and the patient is on federal property, a telehealth visit is perfectly legal. However, if the patient is at home or a private-sector medical clinic, then the physician must be licensed in that state.
VA’s objective is to secure care for veterans regardless of their location. Its hopes lie in the Constitution’s supremacy clause, which declares that federal laws have jurisdictional authority over state laws. By invoking this, Congress can at least ensure that VA clinicians will no longer need to be licensed in the same state they are practicing in.
This big picture solution is aimed at the smallest communities, where telehealth is meant to reach. Many veterans need specialized care that is not available through private providers. Once able to identify a specific need in one area, VA hopes to be able to determine which segments of its community are in need of that type of care and provide it.
Its medical system is run at the local, regional and national level. In rural areas, the department has a rough time recruiting its own medical staff. Most of its 45,000 vacancies are in health care operations. The loss of just one primary care provider could mean at least six months until a replacement is found. At the very least, telehealth could allow any of the system’s other providers to fill in, were it not for state laws.
Regardless of setbacks, the department continues to seek ways to make better use of telehealth. Local facilities without state lines to cross are continuing to flourish. In lieu of legislation, the goal is to integrate telehealth into daily operations. Specialists should have some form of remote or virtual care available to them, in order to make their services more accessible. Patients in need of immediate treatment, such as stroke victims, are the focus of a “tele-stroke” pilot program. In the future, specialty consultant networks may be available to intensive care units at the press of a button.
Access is improved by making telemedicine an option, alongside face-to-face interaction, not replacing it. The Veteran Affairs Department understands this and plans to leave the choice up to the patient. In most cases, it will depend on the type of care he or she needs. In others, it may be a matter of convenience, such as when patients who spend their time in different parts of the country and wish to see the same doctor for all of their visits. The motivation for tomorrow is to extend care to veterans the department isn’t reaching today.