Since 2015, internal working groups and new legislation have made telehealth expansion a priority for the Department of Defense.
But progress has been relatively slow. Roughly 1% of all active duty service members received telehealth services in 2016, and nearly all of those services were concentrated at seven military treatment centers where leaders have encouraged the use of virtual services, according to a report released by the Government Accountably Office on Tuesday.
“Four of the seven facilities maintain telebehavioral hubs while two of the facilities maintain portals that support a high volume of synchronous and asynchronous encounters among patients across the United States and overseas,” the report stated.
Of the nearly 60,000 telehealth encounters in 2016, most were provided in real time via synchronous video. Among all military branches, mental health was the most common service provided via telehealth. Behavioral health advocates and Department of Veterans Affairs Secretary David Shulkin, M.D., have been particularly outspoken about expanding telehealth access among veterans to improve mental health services.
But the DOD’s telehealth numbers are poised to increase for several reasons. Under the National Defense Authorization Act for Fiscal Year 2017—passed last December—the DOD must expand the use of telehealth by June 23, 2018. To do so, the DOD has requested an additional $15.7 million during fiscal year 2018.
The agency could also see a boost in telehealth usage through Tricare members, which accounted for just 27% of all telehealth encounters in 2016, according to the GAO. In July, the DOD revised Tricare policies to allow beneficiaries to receive telehealth care in their homes.
The GAO report noted that 2016 statistics may also be skewed due to chronic underreporting associated with insufficient coding by physicians. An internal audit by the Army found that 30% of telehealth encounters were underreported in 2016. The Army has since added financial incentives and physician training to improve coding accuracy.
Over at the VA, Shulkin has pushed forward a proposed rule that would allow VA providers to practice telemedicine across state lines. Meanwhile, last week the House passed the VETS Act—legislation that mirrors the proposed rule.