The U.S. Department of Veterans Affairs (VA) has come under fire in recent years for a number of systemic issues and for ultimately failing to provide timely access to care for our nation’s Veterans. One consequence of this crisis is that it has pushed the VA into exploring “new avenues” to provide Veterans with care, which have included telehealth options.
Telehealth is defined as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. The VA has increasingly embraced telehealth as a critical tool to improve Veterans’ access to care. The VA currently serves more than 677,000 Veterans through telehealth, which represents approximately 12 percent of the 5.6 million Veterans who receive health care from the VA. The VA provided a total of 2.1 million telehealth visits last year.
Telemental health is the delivery of mental health services using remote technologies when the patient and provider are separated by distance. The VA’s expansive Telemental Health Program is considered to be the largest telemental health network in the world. Its Telemental Health Program enables Veterans to meet with mental health providers through live clinical videoconferencing from VA community-based outpatient clinics, from VA and non-VA health care facilities, and in some cases, from Veterans’ homes. Last year, the VA performed 400,000 telemental health visits. The VA also recently announced the establishment of five new VA Mental Health Telehealth Clinical Resource Centers to provide Veterans, particularly those living in rural and underserved communities, with enhanced access to mental health services. The Mental Health Telehealth Clinical Resource Centers will be located (some are actually already being operated) at facilities in Charleston, SC; Pittsburgh, PA; Salt Lake City, UT; West Haven, CT; and at a consortium of facilities in Boise, ID; Portland, OR; and Seattle, WA. The VA currently employs telemental health to treat nearly every DSM 5 diagnosis, including Post-Traumatic Stress Disorder (PTSD) and substance abuse disorders. It employs most treatment modalities, such as individual and group therapies, medication management, family therapy, cognitive behavior therapies, and psychological testing.
The VA’s National Center for PTSD has also collaborated with the Defense Department’s National Center for Telehealth and Technology to create a free mobile application to help Service Members and Veterans learn about and manage the symptoms of PTSD. PTSD Coach is designed to supplement psychological health care and support received by Service Members and Veterans experiencing signs or symptoms of PTSD. Family and friends of Service Members and Veterans are also encouraged to use PTSD Coach to learn more about PTSD and how to support a loved one suffering from PTSD symptoms. The PTSD Coach application provides 24/7 access to PTSD education, a self-assessment tool, portable skills for acute symptoms, direct connection to crisis support, and information about available treatment. If a Service Member or Veteran is in need of immediate support, PTSD Coach can connect the user directly to the Military Crisis Line for immediate intervention and care.
There is evidence that the VA’s new telemental initiatives are already improving patient care, and other health care systems may look to the VA’s experience when considering implementing their own telemental health programs. However, it is significant to note that the VA does not face some of the regulatory and logistical challenges that have posed a barrier to other telehealth programs. Certain features of the VA structure facilitate a much easier implementation of telehealth programs. For example, VA systems use the same credentialing and privileging, same medical record system, same reimbursement mechanism, same quality management oversight, and same IT department and infrastructure. The VA is also distinctive in that its providers have license portability which allows them to practice in a different state than where they reside or practice. The VA only requires providers to have one active state medical license in order to practice in any VA facility nationwide.
As other telemental health programs look to ease implementation barriers, examining the VA’s telemental health programs may prove useful. If you have questions about telehealth laws and regulations in your jurisdiction, please feel free to contact the Network for legal technical assistance.
This post was developed by Brittney Crock Bauerly, J.D., Staff Attorney for the Network for Public Health Law–Northern Region, with research assistance from Joe Morris, M.P.H. Candidate 2017 and Research Assistant at the Network for Public Health Law.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult an attorney in their state.