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House passes bill taking VA telehealth across state lines

By NIKKI WENTLING | STARS AND STRIPES Published: November 7, 2017

WASHINGTON – Cameras attached to the monitor of psychologist Harrison Weinstein’s computer projects his image to patients far from his office on the Department of Veterans Affairs campus in Salt Lake City.

Weinstein, who’s part of a post-traumatic stress disorder team in Salt Lake City, as well as VA doctors across the country, use telehealth capabilities to reach veterans they otherwise couldn’t treat. Sometimes, they’re truck drivers who reach him from a rest stop in rural Utah, Weinstein said. In other instances, he helps understaffed or overburdened clinics as far away as Louisiana by treating veterans through telecommunication.

“It’s been one of those things that was coming for a long time, and we knew it was just around the corner,” Weinstein said. “We’ve turned that corner. It’s only going to grow from here.”

The VA introduced telehealth more than a decade ago. In 2016, the agency reported about 677,000 patients – 12 percent of the veterans enrolled in VA health care – used telehealth in some form.

Under legislation the House passed Tuesday, that could expand significantly.

The Veterans E-Health and Telemedicine Support Act would allow VA doctors to treat patients across state lines, carving out an exemption to state licensing requirements. If the exemption were implemented, VA providers would be able to reach more veterans who lack access to VA facilities – and more veterans could be treated in their homes.

When doctors treat veterans in different states through telehealth now, the patient and provider must be on federal property – meaning veterans are still required to drive to their nearest VA clinic.

“As long as they’re on a federal facility, I can be licensed anywhere and see them,” Weinstein said. “But locally, if I have a veteran in rural Utah, we will do telehealth to home. They can be sitting in their living room at home, and we can do therapy that way. If it’s out of state, they can’t do that.”

Though the House approved the bill Tuesday, the Senate must pass the measure before it can become law.

VA Secretary David Shulkin, who is a physician, has lauded the agency’s telehealth program and said he still uses it to communicate with patients at a clinic in Grants Pass, Ore. He and President Donald Trump announced at the White House in August that they would change VA rules to allow doctors to practice telehealth across state lines.

According to staff of the House Committee on Veterans’ Affairs, the bill would give legislative authority to that initiative.

The change has received wide support from the medical community, including the American Medical Association, the American Association of Nurse Practitioners and dozens of other organizations that wrote to the VA about it. A public comment period on the rule change ended Nov. 1.

One group – the Medical Board of California – opposed the measure. The board wrote a letter, signed by Executive Director Kimberly Kirchmeyer, that said only physicians and surgeons licensed in California should be allowed to practice there.

“This bill would undermine California’s ability to protect health care consumers, as the board will have no ability to discipline VA providers that are licensed in another state,” the letter reads.

Rep. Glenn Thompson, R-Penn., and Rep. Julia Brownley, D-Calif., sponsored the bill, and both have touted it as beneficial to veterans in rural and medically underserved areas.

In particular, VA telehealth could help veterans receive mental health care, Weinstein said. He sees a problem with patients canceling or missing appointments that they might be able to complete through telehealth. Mental health care is also an area of the VA that remains understaffed.

At a recent congressional hearing, Shulkin addressed the agency’s problem with recruiting and retaining mental health care providers. Last year, the VA set a goal to hire 1,000 mental health care providers, and it hired 900, he said. However, 945 others left the VA.

“A big chunk of my case load is veterans who don’t live here. It solves a lot of access issues,” Weinstein said. “At an even lower level, it solves things like parking and veterans’ driving time. A lot of vets prefer it.”

The Veterans E-Health and Telemedicine Support Act was one of 14 veterans-related bills the House passed Monday and Tuesday, leading up to Veterans Day on Nov. 11.

Also passed Tuesday was the Veteran Urgent Access to Mental Healthcare Act, which expands on policy that Shulkin implemented during the summer to provide emergency mental health care to veterans with other-than-honorable discharges.

If approved by the Senate, the bill would allow veterans who are barred from VA health care to undergo a mental health assessment before they’re in crisis. Veterans must have served in combat or been the victim of sexual assault or harassment while in the military.

“This bill passing the House today shows the momentum that we are gaining in undoing the damage of decades of bad-paper military discharges,” said Kristofer Goldsmith, an Iraq War veteran who advocates on behalf of veterans with other-than-honorable discharges.

Another bill passed Tuesday designates a museum under construction in Columbus, Ohio, as the National Veterans Memorial and Museum.

Wentling.nikki@stripes.com
Twitter: @nikkiwentling
 

The House of Representatives side of the U.S. Capitol.
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