VA Proposed Rule Looks to Expand Telehealth Services

AAFP Wants to Ensure Vets' Access to Primary Care

November 06, 2017 11:22 am News Staff

The AAFP supports America's veterans and the Department of Veterans Affairs (VA) -- the federal agency charged with overseeing veterans' health care, so it should come as no surprise that the AAFP made a point of responding to a recently published proposed rule(www.gpo.gov) titled "Authority of Health Care Providers to Practice Telehealth."  

[Sign outside a Department of Veterans Affairs facility]

In an Oct. 31 letter(3 page PDF), the AAFP noted that the VA proposes to "exercise federal preemption of state licensure, registration and certification laws …" when those state laws hinder the ability of health care professionals to practice telehealth "while acting within the scope of their VA employment."

The letter, which was addressed to Kevin Galpin, M.D., executive director of telehealth services at the Veterans Health Administration Office of Connected Care, and signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., acknowledged the VA's goal of increasing beneficiary access to mental health services, specialty services and general clinical care, and then lauded the the skills of primary care physicians.

"The AAFP strongly believes our veterans are best served by having access to comprehensive primary care services provided by well-trained family physicians and other appropriate primary care physicians," said the letter.

"Telehealth services can be an adjunct in certain situations but cannot replace a meaningful relationship with a personal primary care physician."

The AAFP offered "qualified support" for the VA's proposal to expand clinically validated telehealth services because the proposed rule

  • ensures patient protections would stay intact within the VA's health care system, and
  • states that the program's multistate licensure exception would apply only to physicians and other health care professionals who are employed by the VA.

However, the letter noted that the AAFP continues to support state-based licensure and regulation of physicians and other health care professionals, and the ability of states to regulate telehealth in their jurisdictions.

The letter noted the AAFP's longstanding opposition to federal or legislative action that would supersede state restrictions on licensure but said, "in this narrow case of the VA, federal preemption of state licensure could possibly serve the public interest," and therefore, "justifies a very limited exception."

The AAFP called on the VA to ensure that veterans have "full access" to primary care services.

"We caution the VA to not substitute telehealth services for providing veterans access to meaningful and comprehensive primary medical care," said the letter.

Along those lines, the AAFP suggested ways to expand veterans' access to non-VA entities and health care professionals. The letter called on the VA to

  • pay contracting physicians at or above Medicare levels,
  • allow the collection of applicable copayments and deductibles at the time of service, and
  • include rural health clinics in the Veterans Choice Program.(www.va.gov)

Furthermore, said the AAFP, the VA should expand veterans' access to primary care by implementing policies that would ensure that civilian family physicians can provide primary care services to veterans. The VA should allow civilian FPs to

  • order diagnostic tests at VA facilities and
  • refer patients to specialist physicians and other health care professionals at VA facilities.

The VA should also allow prescriptions written by civilian FPs to be filled at VA facilities.

"As the only medical specialty society devoted solely to primary care, the AAFP is engaged in virtually all health care issues including coverage, cost and quality regarding the administration of the VA's benefits and services for veterans," the letter concluded.

Related AAFP News Coverage
Graham Center Research
Despite Interest, FPs Cite Barriers to Use of Telehealth

(5/16/2017)

Bill to Expand Telehealth in TRICARE Preserves State Licensure
(12/14/2016)

Change Doubles Number of Vets Eligible for Care Outside VA
(3/25/2015)

More From AAFP
Telehealth Member Interest Group

Policy on Telehealth and Telemedicine