The Veterans Affairs Department reported significant telemedicine growth for fiscal 2019, the first full year since implementing a policy that lifted state licensing requirements for VA providers practicing virtual care.
State licensing restrictions have posed a challenge for telemedicine adoption nationwide, and some have suggested the VA's policy could be a first step toward thinking about a national medical practice licensing concept.
More than 900,000 veterans used VA telemedicine services in fiscal 2019, up 17% from the previous year, the VA said Friday.
"VA is committed to offering veterans the healthcare they deserve, whenever and wherever they need it," VA Secretary Robert Wilkie said in a statement.
Growing use of telemedicine among veterans is reflective of the U.S. population at large.
The VA has offered telemedicine services for years, said Dr. Ron Moody, chief medical officer at consulting firm Accenture's federal services division, though that historically involved connecting clinicians and patients in one facility to clinicians in another facility. Most of the VA's recent growth has come from its push to serve patients at home, outside of a hospital or clinic, he said.
That's in part as a result of recent policy changes at the VA, which have allowed the agency to cut across some of the regulatory barriers hindering increased telemedicine adoption in the private sector.
State licensing requirements have posed a major hurdle for many healthcare organizations, according to a 2017 survey conducted by law firm Foley & Lardner. State-by-state licensing often means that a physician practicing in one state can't conduct a video visit with a patient located in another state.
Those licensing restrictions have made it "very complicated" for national and regional health systems to roll out telemedicine programs, since not all of the system's providers will be eligible to provide care for each of the system's patients, said Dr. Kevin Vigilante, executive vice president at consulting firm Booz Allen Hamilton.
That's something the VA has been able to bypass through a federal rule finalized in May 2018, which overruled requirements for state licensing—allowing VA physicians and nurses to administer care to veterans via telemedicine across state borders.
The rule's helped the agency to make telehealth as "effective as possible," said Alex Lennox-Miller, a senior analyst with market research firm Chilmark Research.
That not only alleviates barriers for patients seeking input from specialists out-of-state, but also helps the VA to "balance resources," Vigilante said, focusing on having an appropriate amount of providers who can use telemedicine to serve the VA's patient population, without regard for their location.
The VA plans to make all primary-care and mental-healthcare providers available to deliver care to patients in person and via telemedicine by the end of fiscal 2020.
The 2018 rule was part of an initiative the VA calls "Anywhere to Anywhere," which the agency unveiled in 2017 during Dr. David Shulkin's tenure as VA secretary. The rule, which the VA proposed in late 2017, was finalized in May 2018 after Wilkie assumed the VA secretary role in an acting capacity.
"This new rule is critical to VA's 'Anywhere to Anywhere' initiative," Wilkie said at the time. "Now that the rule has been finalized, VA providers and patients can start enjoying the full benefits of VA's telehealth services."
The "Anywhere to Anywhere" program applies to any telemedicine services that veterans access, whether at a VA facility, online through a website or through VA Video Connect, a telemedicine app the VA began rolling out in 2017. Through the app, veterans can schedule video appointments and message their providers.
More than 99,000 veterans used the VA Video Connect app in fiscal 2019 to complete roughly 294,000 video sessions, more than two-thirds of which were for mental healthcare, the VA said.
The VA did not share the top specialty or use case for its telemedicine services overall and didn't respond to a request for comment on its telemedicine services.
With private-sector hurdles like state regulation accounted for, ensuring that veterans are in areas with the broadband infrastructure needed to complete high-quality telemedicine visits is the main challenge that remains for the VA to tackle, Lennox-Miller said.
Nearly one-quarter of veterans live in rural regions, according to findings that the U.S. Census Bureau released in 2017. And roughly 31% of rural residents lack access to wired broadband that meets the Federal Communications Commission's speed benchmark, according to a 2018 FCC report.
That's something the FCC is working to address through the Connected Care Pilot, a $100 million pilot program the agency has proposed to promote telemedicine services. The program would support a limited number of projects to help "defray" the broadband costs of bringing telemedicine to low-income Americans and veterans.
"That's the single biggest barrier," Lennox-Miller said of the dearth of high-speed internet in rural areas.