Department of Defense Expands Use of Telemedicine

Telemedicine continues to be a burgeoning industry, lauded by proponents who feel that it provides time-sensitive care to patients who are geographically isolated or physically disabled, or who don’t have the time to travel to see a specialist.  Most state medical boards require doctors to be licensed in the state in which the patient receives care.  With respect to patients of Department of Defense (DOD) health care professionals, however, that limitation is changing.  A bill recently introduced in Congress would make the same changes for patients of the Veterans Administration (VA).

The DOD and the STEP Act

The Servicemembers’ Telemedicine and E-Health Portability (STEP) Act was introduced by Representative Glenn Thompson (R-PA) in May 2011.  It was incorporated into the National Defense Authorization Act for Fiscal Year 2012 (P.L. 112-81) as section 713 and became law on December 31, 2011.  Thompson was motivated to introduce the bill to aid service members who require mental health treatment and may be suicidal, although proponents see tremendous applications for physical health issues, as well.  The bill permits health care professionals employed by or contracting with the DOD who are licensed in their profession to provide telemedicine services to active duty service members, veterans, reservists, and guards, regardless of their locations.  This means that a physician licensed in Hawaii could treat a service member in Guam; a medic in a field hospital could consult with a doctor licensed in D.C.; or a mental health specialist licensed in New York could counsel a depressed officer at his home in Connecticut.

In addition to providing easy access to care, the use of telemedicine is expected to be cost-efficient.  According to Officer Eric Crawley, Chief of Pulmonary Critical Care at Tripler Army Medical Center in Hawaii, a satisfactory teleconferencing system costs roughly $200,000, which is the same price as medevacing a patient to the United States; the teleconferencing system, however, can be used for multiple patients. Supporters also maintain that providers and patients can develop warm and trusting relationships from afar.

Despite the STEP Act’s passage, the DOD is still in the process of implementing its provisions.  As a start, it effectuated a waiver in 2012 to expand the use of telemedicine throughout the DOD.  However, as Congressman Thompson recently pointed out, the waiver neither allows service members to receive telemedical treatment in their homes nor includes TRICARE providers among those who may practice telemedicine without multiple state licenses.  The DOD has stated that it will update its medical manual and implement the act “soon,” but declined to give a time frame.

The VA and the VETS Act

In May 2013, Representatives Charles B. Rangel (D-NY) and Thompson introduced the Veterans E-Health & Telemedicine Support (VETS) Act of 2013 (H.R. 2001).  The VETS Act would do for the VA what the STEP Act purports to do for the DOD–expand patients’ access to efficient, cost-effective, and potentially life-saving treatment by expanding the number of providers who can treat patients via telemedicine.  In introducing the act, Rangel emphasized the importance of unrestricted mental health treatment.

Although telemedicine is expanding, it is not yet widespread throughout the health care industry.  Perhaps if government agencies affiliated with the military begin to embrace the practice, it will become accepted by other government organizations, insurers, and the general public.