On June 11, veterans will be eligible to receive virtual healthcare from Veterans Affairs providers no matter where they live or where the provider practices in the U.S. This is a sign that we finally are breaking down a bricks-and-mortar mindset that has dominated our healthcare system—the insistence that patients must come to us, the providers, in our workplace to get care.
When this rule goes into effect on June 11, American veterans anywhere—even those in remote, rural and underserved areas, and those who can’t travel for health, financial or logistical reasons—should have access to care.
This is a positive step forward, and one that makes those of us in the healthcare IT industry optimistic that telehealth has a real chance to grow and succeed in this country.
The Department of Veterans Affairs made this happen through a proposed rule entitled, “Authority of Health Care Providers to Practice Telehealth,” which it unveiled last year. The proposed rule called for an amendment to allow the VA to exercise “federal pre-emption” and override state-specific telehealth laws, medical licensing restrictions and other requirements that conflicted with the VA’s need to provide telehealth services across its entire system. Removing those barriers now frees VA healthcare providers to treat beneficiaries using telehealth, irrespective of the state or location of the provider or the beneficiary.
The College of Healthcare Information Management Executives (CHIME) and our members strongly supported the proposal. In a letter submitted to Veterans Affairs Secretary David Shulkin during the comment period, we pointed out some of the potential benefits of telehealth—better access, better outcomes, increased convenience for patients and their families, the ability to “touch” patients whose location or condition impedes in-person care, and an efficient and cost-effective use of the VA’s limited resources.
As the chief information officers and senior IT leaders in our nation’s healthcare organizations, we understand the great potential technology has to improve delivery of care, including remotely.
Our letter also cited a joint 2017 telehealth report by CHIME and KLAS Research based on a survey of our members. The discord between state laws and state restrictions, and the benefits of interstate telehealth services, were common themes among respondents.
Another frequent concern was reimbursement. On this front, state laws were driving reimbursement for some services, “but national legislation is still missing,” according to the report. More than half of respondents said lack of reimbursement was limiting the adoption of telehealth.
We’ve seen progress in federal reimbursement in recent months, too. The Bipartisan Budget Act of 2018 that was signed into law in February included elements of the Creating High Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. The legislation will expand reimbursement for some telestroke and end-stage renal disease services for Medicare beneficiaries, both beginning Jan. 1, 2019. It will allow Medicare Advantage to add clinically beneficial services through telehealth to basic plans, and it will let Accountable Care Organizations expand the use of telehealth services, both beginning in 2020.
Why does this matter? Medicare beneficiaries totaled an estimated 58.5 million people in 2017, according to the Centers for Medicare and Medicaid Services. The Department of Veterans Affairs placed its veteran population at nearly 20 million people in 2017, with about half enrolled in the VA healthcare system.
The increasing acceptance for telemedicine by two prominent national healthcare programs that serve a significant proportion of citizens in the U.S. is paving the way for more opportunities to build off our telehealth capabilities. Their willingness to adequately reimburse telehealth services is a signal to providers and their healthcare organizations that they can incorporate telehealth into the delivery of care without taking a financial blow.
Most importantly, the growing use of telehealth now and in the future gives more patients access to timely and affordable care wherever they live.
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