Bipartisan Senate bill aims to waive telemedicine restrictions for VA docs

A Senate committee heard testimony Wednesday on a bipartisan bill meant to ease telemedicine licensing requirements and facilitate mental health e-visits for Veterans Affairs healthcare professionals.

Current rules call for physicians using telemedicine to be licensed in the state where the patient resides.

According to bill sponsor Sen. Joni Ernst (R-Iowa), state licensure requirements are waived for the VA if both patient and doctor are in a federal facility during the e-visit. Home e-visits are allowed only if the two parties are in the same state. Ernst’s “Veterans E-Health and Telemedicine Support Act of 2015” would allow home e-visits regardless of where the VA clinician is located or licensed. This would apply to both VA-employed physicians and those under contract to deliver care outside of VA facilities.

“That’s a very important issue,” said Dr. Maureen McCarthy, acting VA assistant deputy under secretary for health for patient care services. She added that, under current practice, providers under a national service contract could find it necessary to get licensed in all 50 states.

Some 677,000 veterans received telemedicine services last year including 122,000 who received mental health e-visits in their homes, McCarthy said. She added that this has led to decreased hospital admissions, lower travel costs and fewer missed appointments.

“Telehealth care is an innovative and important means to meet the wide-ranging needs of veterans in Iowa and nationwide, including the invisible struggles of mental healthcare,” Ernst said in a news release.

The bill is sponsored by lawmakers from mostly rural states. It’s main co-sponsor is Sen. Mazie Hirono (D-Hawaii), who says the issue of access is of particular concern to residents of her state.

“Hawaii residents often are forced to drive for hours to see their physician or spend thousands of dollars to fly to Oahu and the mainland to seek care from a specialist,” Hirono said in a news release. “The TELE-MED Act will help to eliminate the financial and physical stress of seeking quality medical care by allowing seniors access to Medicare-participating physicians from the convenience of their home or local doctor’s office.”

The bill had 11 other co-sponsors before the hearing. This was increased during the hearing when the panel’s ranking Democrat, Sen. Richard Blumenthal of Connecticut, added his name to the roster.

Committee Chairman Johnny Isakson (R-Ga.) praised the bill.

“Legislation like this is a godsend, I suspect, and helps us solve a significant problem,” Isakson said.

Along with easing licensing restrictions, the bill calls for assessing patient satisfaction with the service, provider satisfaction, frequency of use, wait times and the effect on access to care.

Though McCarthy said the VA is “thrilled” with the bill, it had some concerns about creating additional reporting requirements – such as provider satisfaction. She added, however, that for the most part, the concerns were over “minor details” that could be resolved.

The bill has been endorsed by the Veterans of Foreign Wars, Paralyzed Veterans of America, the American Legion, Concerned Veterans for America and the American Telemedicine Association.

The Federation of State Medical Boards adheres to the principle that the practice of medicine occurs in the state where the patient is located, which it says ensures oversight and accountability if a patient is harmed.

“In its current form, the proposed VA legislation falls short of ensuring these protections, and it should be amended to strengthen them,” said FSMB Chief Advocacy Officer Lisa Robin.

To facilitate telemedicine access to patients in rural or remote areas, the FSMB advocates states join the Interstate Medical Licensure Compact that was created to streamline the licensing process for doctors practicing in multiple states. So far, 11 states are participating in the compact and legislation to do so has been introduced in nine more, Robin said.

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