VA finalizes interstate licensing rule that will ‘open the aperture’ for telehealth

David Shulkin and Donald Trump
A finalized rule changing licensing regulations is a key part of the VA's Anywhere to Anywhere telehealth initiative. (YouTube)

The Department of Veterans Affairs finalized a much-anticipated rule that allows providers to treat patients across state lines using telehealth, a critical element of a virtual care initiative launched last year.

The new regulation will allow the health system more leeway to integrate telehealth visits as a routine part of patient care, according to Neil Evans, M.D., the chief officer for the Office of Connected Care, who told FierceHealthcare the rule “will really allow us to open the aperture” on existing telehealth initiatives.

Currently, VA patients can receive care via telehealth by going to one of more than 700 community clinics that feature specialty services like telemental health and postsurgical consultations. Up until Thursday, physicians around the country could treat patients that visited those clinics, but licensing regulations prohibited them from performing a virtual visit in a patient’s home if it was outside the state where they held a medical license.

The new rule (PDF), scheduled to publish on the Federal Register on Friday, finalizes last year’s proposal to override state licensing restrictions so clinicians can treat veterans anywhere in the country. The rule is a critical piece of the VA’s Anywhere to Anywhere telehealth initiative, announced last August by former Secretary David Shulkin, M.D., alongside President Donald Trump.

The initiative, which “dramatically expands our current capabilities,” Shulkin said at the time, features a new mobile app that allows patients to connect to clinicians using their smartphone.

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The finalized rule is limited to VA-appointed providers, so it excludes clinicians that provide care through VA Choice program.

Two separate bills have also passed the House and Senate that, if reconciled and signed by the president, would codify similar changes into law. While the new regulation provides some immediate relief, VA leadership remains supportive of the legislation as a long-term fix. 

“Frankly, the legislative solution is preferable to a regulatory solution,” Evans told FierceHealthcare at the HIMSS18 conference in March. “It becomes law and there’s some permanence to it.”

New rule offers new opportunities

During fiscal year 2017, 12% of VA patients that recorded at least one care encounter with the system received a portion of their care via telehealth, according to Evans. That translated to more than 727,000 veterans engaging in some type of telehealth encounter totaling nearly 2.2 million visits. 

But of the 12% that used telehealth in 2017, less than 1% received care at home. The leeway provided in the new rule is expected to boost that percentage.

“Strategically, we want to move more of this care into the home when it's appropriate,” Evans said. 

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A big part of that push will be integrating telehealth into physician workflow by configuring the EHR to include the option for a telehealth visit. The VA also plans to build on an online scheduling app released last year that allows patients to book appointments online. At some point in the future, patients will be able to book a telehealth visit as well.

Already, some VA providers have been improvising with the new functionality of the Anywhere to Anywhere program, using virtual visits to enhance phone appointments or schedule follow-up care. Leveraging those experiences will be key since “adoption goes through the roof” among patients when physicians recommend any type of virtual modality, Evans said. 

The agency also plans utilize its 10 telemental health hubs to provide in-home services to patients around the country.

“When that infrastructure is in place, I don’t think providers really struggle to see the value [of telehealth],” Evans said.

“It’s part of a new skill set for clinicians to understand not just what pharmaceuticals I should be prescribing, but what modalities should I be using to deliver this healthcare,” he added.