Telehealth Regulation States Rights

Veterans Affairs Trumps States Rights With Telehealth Expansion Laws

The Department of Veterans Affairs just passed a new federal regulation to allow its doctors, nurses and other health care providers to administer care to veterans using telehealth or other virtual technology to anywhere in the United States that trumps states rights.

The new regulation, 38 CFR § 17.417, is designed to support the Fall 2017 “Anywhere to Anywhere VA Healthcare Initiative” unveiled by former VA secretary David Shulkin.

“What we’re really doing is, we’re removing regulations that have prevented us from doing this,” Shulkin said at an event attended by President Donald Trump. “We’re removing geography as a barrier so that we can speed up access to Veterans and really honor our commitment to them.”

The agency issued its final rulemaking May 11, 2018, and it will go into effect June 11, 2018. Not only does the law expand telehealth, but it preempts state laws on the subject. So, in the name of “helping veterans,” the federal government is eroding a state’s ability to protect their citizens.

RELATED: VA To Follow Failed DOD Plan With Cerner EHR Contract

Telemedicine Explained By Insurance Agent

So what exactly is telemedicine? Why should I care? And, who stands to make some money providing doctor-on-demand services or subscriptions in the private sector using telemedicine techniques?

Who better to explain this than an insurance agent? I found the below clip and thought some of you might find the explanation useful from a private sector view.

Regulation Excerpt

The following is an excerpt from the new regulation as written in the Federal Register. Apply what you just learned from that video to the new regulation language:

(b) Health care provider’s practice via telehealth. (1) Health care providers may provide telehealth services, within their scope of practice, functional statement, and/or in accordance with privileges granted to them by VA, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located. Health care providers’ practice is subject to the limitations imposed by the Controlled Substances Act, 21 U.S.C. 801, et seq., on the authority to prescribe or administer controlled substances, as well as any other limitations on the provision of VA care set forth in applicable Federal law and policy. This section only grants health care providers the ability to practice telehealth within the scope of their VA employment and does not otherwise Start Printed Page 21907grant health care providers additional authorities that go beyond what is required or authorized by Federal law and regulations or as defined in the laws and practice acts of the health care providers’ State license, registration, or certification.


(c) Preemption of State law. To achieve important Federal interests, including, but not limited to, the ability to provide the same complete health care and hospital service to beneficiaries in all States under 38 U.S.C. 7301, this section preempts conflicting State laws relating to the practice of health care providers when such health care providers are practicing telehealth within the scope of their VA employment. Any State law, rule, regulation or requirement pursuant to such law, is without any force or effect on, and State governments have no legal authority to enforce them in relation to, this section or decisions made by VA under this section.

Supports Of Expansion

The initiative was supported by many organizations, including the American Telemedicine Association, American Association of Family Physicians, AAFP, American Medical Informatics AssociationFederal Trade Commission, the College of Healthcare Information Management Executives (CHIME), Teladoc, Oracle, the American Psychological Association, the Brain Injury Association of America, the National Association of Social Workers, the University of Pittsburgh Center for Military Medicine Research and Health IT Now.

“This proposed rule will be instrumental in breaking down geographic barriers that, for too long, have prevented our nation’s heroes from accessing the care they need where they need it,” Joel White, the group’s executive director, said in a Sept. 29 blog post. “By allowing VA telehealth providers to more easily treat patients across state lines, we can ensure that recent advances in technology-enabled care reach the most deserved among us and spur better outcomes for the 20 million veterans in the VA system today.”

How much do you think these organizations and vendors paid to lobby Congress and VA about expansion of telehealth?

“The VA’s decision to allow veterans to access care from the comfort of, or closer to, their own homes is necessary to improving quality and timely care for the more than 200,000 veterans in Iowa, particularly those who are disabled or reside in rural communities,” Sen. Joni Ernst (R-Iowa), a National Guard veteran, said last fall“It is critical that we continue to create opportunities for veterans to receive the best care out there, including potentially life-saving mental healthcare. Improving the VA’s telehealth program is critical, and I am thrilled to see this common-sense measure will be put into action to benefit Iowans and veterans across the country.”

The Slippery Slope

Here is the rub with expansion of telehealth based on previous moves by VA to expand access to clinicians by lowering the bar for qualifications to serve as Primary Care Providers.

Last year, VA finalized its regulations that allow advanced practice nurses and clinical pharmacists to serve as Primary Care Providers (PCPs) asserting the lack of access to doctors results in veterans going without care. So, to counter this trend, VA simply wants to lower the bar to serve as a veteran’s PCP.

RELATED: Clinical Pharmacists Can Be Your PCP

RELATED: Advanced Practice Nursing Push To Usurp Role Of MDs

The agency cites Clinton-era Federalism executive orders as granting authority to allow such clinicians to serve in that role even if their own state licensure may not provide or facilitate adequate oversight of the same.

In the long run, what we are seeing is a rush to the bottom by exchanging the practice of medicine with health care. Clinicians now follow algorithms using “evidence-based care” parameters without evaluating patients in the manner doctors of old used to.

As a result, many conditions and illnesses are falling through the cracks and overall medical care suffers.

There is mainly a financial incentive to lower the bar to serve as a PCP. It costs less to hire a nurse practitioner than it does a medical doctor. I suspect the Insurance Industry is behind pushes like this so as to lower the overall cost of health care in the US through gradual erosions of quality standards.

RELATED: Foreign Google-owned Company To Datamine Your Health Records

Now enter telehealth.

By lowering the qualifications to serve as a PCP, and coupling that with expansion of telehealth, anyone can serve as a PCP in any state regardless of the state’s licensure rules so long as they were working inside VA.

Once the data on efficacy is massaged to support expanding this type of care to all Americans, the VA model will be the model of health care for the not-rich, nationwide.

Now, who decides what the standard of care should be in that instance? Could the standard of care in a particular state, say New York, be lowered to match that of another state, say Mississippi, if a federal standard seeking the cheapest effective care model of, say, England?

When I was stationed there, we had many friends in the community who were on national welfare waiting for basic surgeries like hernia repair for years and unable to work while waiting for their spot. Did these folks enjoy waiting? No. They wanted to earn a living.

The slippery slope problem I see is a rush to the lowest standards of care in the nation and adoption of that standard for everyone in the name of lower costs for insurance companies while medical device companies stand to make a fortune by supplanting real-life doctors.

RELATED: Facebook Algorithm Flags VA YouTube Video As Fraudulent Spam

As for the new VA language as highlighted in the below press release, the legislation is aimed at allowing virtual technology to facilitate the law. How long before we receive treatment from DARPA / Boston Dynamic designed robots presently being built to replace soldiers in combat?

Wait a sec. Didn’t Google own Boston Dynamic?

RELATED: Google Buys Boston Dynamic, Sells It To Japanese Company

Remember Elysium?

Has anyone ever seen Lawnmower Man? What about Matt Damon in Elysium where the protagonist receives health care treatment from a robot?

“Please sign this to receive your medication…. Thank you for your service.”

How long before this is your next VA PCP?

“Hello Veteran 0. Today, your doctor is Android 15 powered by IBM Watson.”

Personally, I am concerned about the apparent race to the bottom and overall decline in American medicine. Please reach out with your thoughts on erosion of states’ rights by the federal government by commenting below.

Below are complete articles from three VA publications about this next stage.


VA Expands Telehealth by Allowing Health Care Providers to Treat Patients Across State Lines

WASHINGTON — Today the U.S. Department of Veterans Affairs (VA) announced a new federal rule that will allow VA doctors, nurses and other health-care providers to administer care to Veterans using telehealth, or virtual technology, regardless of where in the United States the provider or Veteran is located, including when care will occur across state lines or outside a VA facility.

Previously, it was unclear whether VA providers could furnish care to Veterans in other states through telehealth because of licensing restrictions or state-specific telehealth laws. This new rule exercises federal preemption to override those state restrictions, paving the way for VA to expand care to Veterans using telehealth. VA worked closely with the White House Office of American Innovation and the Department of Justice for implementation of the new rule.

“This new rule is critical to VA’s ‘Anywhere to Anywhere’ initiative,” said VA Acting Secretary Robert Wilkie. “Now that the rule has been finalized, VA providers and patients can start enjoying the full benefits of VA’s telehealth services.”

By enabling Veterans nationwide to receive care at home, the rule will especially benefit Veterans living in rural areas who would otherwise need to travel a considerable distance or across state lines to receive care. The rule also will expand Veterans’ access to critical care that can be provided virtually — such as mental health care and suicide prevention — by allowing quicker and easier access to VA mental health providers through telehealth.

VA first announced the proposed rule, titled “Authority of Health Care Providers to Practice Telehealth,” at a White House event last August, during which VA and President Donald Trump launched the “Anywhere to Anywhere” initiative.

In the announcement, VA also unveiled VA Video Connect, a video conferencing app for Veterans and VA providers. Through this new rule, VA providers will be able to use VA Video Connect and other forms of telehealth to furnish care to Veterans anywhere in the country, including in the Veteran’s home.

To learn more about VA’s telehealth “Anywhere to Anywhere” initiative, visit VA’s Office of Connected Care at



New VA Video Connect Appointment App

The new VA Video Connect application connects Veterans with their health care team from anywhere, using encryption to ensure a secure and private session. The app makes VA health care more convenient and reduces travel times for Veterans, especially those in very rural areas with limited access to VA health care facilities, and it allows quick and easy health care access from any mobile or web-based device.

To access VA Video Connect on your Apple mobile device, you will need to download the free VA Video Connect iOS app from the App Store. If you previously connected to VA Video Connect through Pexip, you may need to follow these steps to be correctly routed to the new VA Video Connect app

Veterans and their health care providers jointly decide whether to use VA Video Connect for a medical visit. Please confirm with your provider that you can start scheduling appointments on VA Video Connect after the implementation date.

Note: To test whether your personally owned device is compatible with VA Video Connect, visit the VA Video Connect test site on your mobile device.

For guidance on how to access VA Video Connect when using an Android Device, visit the quick guide. For guidance on how to access VA Video Connect when using an iOS Device, visit the quick guide.

More information may be found below and on our FAQs page. For questions about and/or technical assistance regarding VA Video Connect, please contact the National Telehealth Technology Help Desk at (866) 651-3180 or 703-234-4483 on Monday through Saturday, 7 a.m. through 11 p.m. ET.


Telehealth Revolutionizing Veterans Health Care

The Department of Veterans Affairs is revolutionizing the use of new health care technology to deliver convenient, accessible health care to Veterans. VA’s TeleHealth service is mission critical to the future direction of VA, and utilizes health informatics, disease management and telehealth technologies to care for and provide case management. More importantly, it helps Veterans to continue to live independently; in their own homes, local communities and stay out of the hospital.

“Technology is the tool the Veteran utilizes through TeleHealth Service to interact with their care coordinator, but the real key component to the success of the program is case management and personal connection,” says Catherine Buck, National Home Telehealth Lead and Clinical Nurse Analyst. “The Veteran establishes a relationship with a go-to person that is essential for the Veteran’s overall health care plan and personal health goals.”

Ultimately, telehealth changes the relationship between patients and their health care team. Higher levels of patient satisfaction and positive clinical outcomes can attest to this.

“VA providers and patients discuss and decide together which telehealth care services are available in their location and clinically appropriate for the patient, said Bay Pines VA Healthcare System’s Virtual Care Program Coordinator,” Rod Miles.

Telehealth practitioner Dr. Paul Maas (foreground) is joined via video by Rod Miles, facility telehealth coordinator at Bay Pines VA Healthcare System.

There are many telehealth resources that are used to deliver care to a patient. However, VA’s Video on Demand has been an important resource for providers and patients at the Bay Pines VA Healthcare System for the past three years.

“Veterans don’t need to be at a clinic to speak with their provider thanks to VA Video on Demand. Providers refer appropriate patients to participate in this program. This telehealth tool is a secure, web-enabled video service, connecting Veterans with their providers using their personal mobile phones or computers, Miles said.

Veteran Katrina Pettus utilizing VA Video TeleHealth Technology to connect with TeleHealth Presenter, Demion Young

U.S. Army Vietnam Veteran David Miller has been utilizing VA TeleHealth services to assist with the treatment of his diabetes. “I’ve had nothing but the best experience. I think they saved my life. They made dealing with my diabetes much easier. They even gave me a Medtronic device which measures my blood pressure, blood sugar and weight. All I need to do is send my coordinator my results before bed. Telehealth has really helped me to stay on track.”

Another benefit Mr. Miller receives from receiving telehealth care is that he is able to communicate with a pharmacist every couple of weeks to ensure that his medications stay up-to-date with his changing medical needs.

“The overall coordination of my care is more convenient. A pharmacist communicates with me about every three weeks. If there is a need to change what I’m taking, we do it. It makes me feel safe. I’m also about an hour and a half away from the closest VA clinic so; it helps to minimize the number of trips I have to take to see my providers.

“I’d recommend this program to absolutely anyone. They really go above and beyond in making sure that I am cared for and that my health care needs are met. They really know what they’re doing,” Miller said.

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  1. ” “We’re removing geography as a barrier so that we can speed up access to Veterans and really honor our commitment to them.”

    The agency issued its final rulemaking May 11, 2018, and it will go into effect June 11, 2018. Not only does the law expand telehealth, but it preempts state laws on the subject. So, in the name of “helping veterans,” the federal government is eroding a state’s ability to protect their citizens.” Unquote.

    Woke up with the above rolling around in my head. Plus what was told to some of us at the VA about them and others ‘having to protect us from ourselves.” Sound familiar? And all this over-riding rules/laws, privacy, safety nets, Constitutions, turned us into a fascist police state with us being on domestic terrorist lists, unable to fight all the corruption or attacks going on with some of us all in the name for “helping veterans,” being “sustainable.” While using tactics against pain meds, “collective punishments” a war crime against us all in order to “help” or save?


    Data collecting:

    JBWells interview with agent. It gets interesting.
    “American People Warned about the true head of the shadow government”

    So far in my life I have seen and been shown I have no rights or very few. No legal aid to be found unless I become super wealthy. State and local governments tend to do whatever they desire or to allow the feds to rule the roost over such protections that will be abolished. Then to think at this same time Indiana has allowed for those refugees to DACA jokers the ability to move on up in power positions, into health care positions, their beloved white collar jobs/Tech and computer industries/programmers etc., while those in DC are claiming to debate the lost issue.

    Plus what has happened to me personally over the past few years or more. Then throw in all the side corruption, retaliation, identity politics, activist, and severe censoring? Hmm, no need for warrants or probable cause etc. I think the masses better wake up and this issue needs to go back to the drawing board. And if those need and want this type of stuff? Go for it. Make a law for others to totally opt-out of such goings on.

    I guess for those of us living in totally corrupt towns, with state support and not giving a damn about us or this country will have to just endure and watch the house of cards and circus fall, hopefully. Coffee.

  2. Who they fooling? No urgency, no change. Simple as that. No fuss, stress, confusion, or hesitancy coming to this conclusion. Getting awfully tired, and disgusted with all the BS.

    I had PTSD Tele-Health, what a joke. No professional feedback from a Certified Practitioner, like most times, I had a VA Nurse. Wow. A lot got done don’t you think? Right.

  3. It might make it more difficult to check my prostate whilst having both hands on my shoulders.

    Or when I say it hurts “down there” and I hope that the camera resolution is good enough to focus on my junk.

    Cynical? Maybe just a little. But it might be more convenient if I find myself remote and the unlikely odds of having Wi-Fi is available.

    1. The VA Telemedicine would like to put your fears to rest:

      We simply would have you sit your bare ass down on an iPad Pro in order for our trained hacks to view you truly brown-eye to brown-eye. The VA Cares!

      1. Namnibor

        The prostate exams will now be included in the new Lemmiwinks DIY Colonoscopies offered by VA Tele-Med Systems. Using the miniaturized wireless GoPro helmet cam and a gerbil which is Linked wirelessly to the Tele-Med System.

        Although the kit is still in development being researched and tested in a small town, named South Park, near the new, may open this year, Aurora VAMC.

        A short Video of some of the early testing:


      2. Thanks Seymore, now I can’t get those images out of my head with them varmints running up my colon with cute little GoPro helmet cams. Funny stuff.

        With all the mingling and experimenting going on in Indiana, all the secrecy, Frankensteins in our ruling colleges, VA, politicians, health care worker types here/activist/unions I bet the little rodents would get their virgin voyages up some poor Hoosier vet/townie’s rear. Who knows what happens anymore when we are put to sleep and lying on a stainless steel slab alone with some of these vile creatures in white surrounding us. Frightful.

        Or having our intestines and colon replaced by ones from a pig or goat. While they may claim all our ills are due to our diet. They can change that in the future.


        Colleges, schools of medicine, the NWO crowd, lefties, are taking over the works. Plus getting grants to study animal implants in humans. Oh robotic stuff including doing more surgeries.

        Locally the colleges have full control over pubic school n’ brainwashing already. Next!

        VA’s buddies IU and others must be upsetting some wealthy clique or witches coven, whatever. As this citizen, vet, reporter was told… “The VA, IU” among others “totally controls veteran’s and health care in Indiana.” “Leave their care or diss them you’ll never find health care in Indiana again.” The scum has and is proving that threat to be totally true, obviously. To me it is.

        Odd, surprised this made the news. I was informed locally that hospital security will not or would not accept hospital staff complaints, wrong doing, investigate complaints or issues dealing with the same entity that employs them, “their bosses.” But then again I not a fondled female and death threats, discrimination, malicious harassment among other things aren’t just that important. The victim there must have been in a clique if true.

  4. Why the hell not allow telehealth. Seriously, when is the last time your doctor actually touched you? (Be nice boys). Doctors no longer palpate, thump, tap, twist, bend, extend or anything. The only thing missing is ye olde stethoscope for the lung gurgle and bla dump bla dump bla dumpty dumpty beeeee deeeee deeeee. If I look back 15 years – half VA half Pig Med, there hasn’t been any hands-on that most of should remember from our youth to mid-life. Now, the VA docs are sitting in front of a monitor looking for shit that isn’t there, and typing furiously to tick the boxes of bureaucracy. Nothing a good (I said “good”) nurse couldn’t do.

    Hey – speaking of States’ Rights, will the VA allow medical marijuana? Please – for us, not the docs.

  5. For a places like Alaska, Montana, Idaho, Maine, etcetera, tele-health is a good thing – it has actually been done for years because the lack of private practitioners and remote locations. Also, if you are just going to do a ‘check in’, then tele-health works. However, tele-health should not be used for psychiatric disorders and treatment – these conditions deserve one-on-one health care. There should be a wait-and-see on this program. With respect to being treated by a nurse, demand a doctor period.

  6. Need to start holding POTUS Trump accountable for the promises he made during the Presidential Campaign, and what POTUS mentioned in his first State of Union Address. Did you forget already? Well, it’s not unpatriotic to hold a President accountable, he made the promises not anyone else.

    It would seem to be a good idea that Trump should start calling out ALL the Politicians who need to get working on the VA. The needs of the 21st. Century Veteran aren’t being met. IMO

    1. WTF I replied with a long story i never got to finish my post before it cut me off. What is it Ben, this is bs

      1. @Dino – Must been acting up like crazy on you. Your post is under my comment. What’s that all about?

    2. Nutter, it would be nice to be able to hold liars, polticians and others acountable for their promises but too many generations have made such things comedy, jokes, and impossible. Now it’s legal for many to lie to us then on top of that ‘exempt from prosecution’ or simply above the laws and any laws of decency. Those jumping on the ‘band-wagons’ staying true to their personality likes instead of principles and promises will rarely change. Putting us on more dis-like lists or not able to play in others sand boxes for dissing their picks or who are pleased with the liars. Way past time for some changes in attitudes and actions.

      Strong accountability, and enforcing some laws, stop playing politics/professional cliques and covering-up for the corrupt should start from the top, like with Trump, should have been with all before him, then swiftly down to the local scum who don’t care one bit about facts, truth, promises, or any of us suffering or dying. All that crap over the generations till today is set in concrete.

      Pity in this age promises, their word, handshakes, facts or truth is not wanted and really not wanted and hated.

  7. Hold the phone a second here!
    There are two sides to this coin. Give me a fair chance to explain before lobbing snipes!

    I don’t see telehealth as a program intended to replace any established VHA care but, rather as a way to assist in that care, and where this enactment is creating a much needed bridge in the healthcare from VHA.

    There has long been the problem of patient appointment availability. Many have said they can’t get timely visits to have certain of their conditions evaluated/monitored. There are times when a patient’s condition(s) just do not require an actual hands on, in the room care/follow-ups to established medical history. There will always be times where a patient needs in person visits, and there telehealth can free up precious appointment times allowing for that care. Versions of telephone/web based healthcare have been widely used in civilian care for a several years now and it is growing in use by practioners and patients. I don’t see VHA telehealth as more than another assistant for the primary provider.

    A patient living in a rual area will have different transportation needs/challenges compared to an urban dweller. Both, can have relief of those hassles be they from nature’s elements, infrastructure repairs, or their own medical limitations, as examples. Let’s say a round-trip for monitoring care will take three hours, if a five minute phone conversation can accomplish that task, wouldn’t you want that three hours plus waitroom time, to do as you please? If a condition arises after standard clinic hours, I’m assuming there would be staff available to assist the patient/caregiver calling telehealth. This might also be a possible assist to triage emergant care to local facilities if warranted, and easing a few future hassles from that care. Some years ago, VHA had the tel-a-nurse program that did some of those things.

    Many have voiced concerns about ANP’s as PCP’s, and this issue is a fork with several tines.
    Yes, there is a difference in training/experience levels between doctors and nurses. Also, consider the vast differences in the training/experience comparatively in their own grouping. There are some doctor’s that are ill equipped to practice as primary’s, precisely because they focused their attention on a specialty practice. It may be that a facility is expanding and hiring certain specilaty practitioners for that growth but, they need a few primary slots temporarily utilized, or that doctor is biding their time-in to pay off student loans. By taking the first minutes with a new provider to establish briefly, your needs and their desire to continue practice as a primary, can be beneficial in getting the patient the proper care. Granted, this is not going to work if you have rotating students under your primary’s “care” offerings. There are wonderful NP/ANP’s that understand when the doctor is needed and just how to word the patient’s related history to get the required care. A nurse as a primary can be an asset if you come prepared to help him/her guide your care according to what you think might help your situation; unfortunately, too many doctors will never allow a patient the luxury of patience.

    As far as state licensing, this is a different kettle of fish altogether!
    For example, if your time in service was stateside, you could keep your home driver’s license, thereby overriding your DS state requirements; I’m not aware of that changing. My memory wants to recall something about a national driver’s license but, I’m not going there here! It seems that VA practitioner’s have a similar allowance with their medical license wherein they do practice irrespective of state boundries. I assume they would be required to follow that state’s practicing guidelines, much as you do when driving.

    Lastly, I too, can see the ramifications of several areas of abuse and the potential of uncle’s plans to derail at some place in practice but, I see significant benefit for a large percentage of the veteran population. For now, I think telehealth could enjoy better success and fewer glitches overall than Choice ultimately showed. Again, I don’t see it as a program intended to replace any established VHA care but, rather as a way to assist in that care.

    1. Yeah Rosie it could be a good thing but still a double edged sword that can cut both ways. All of our physical meeting groups here were cancelled and replaced with telehealth. Which most of the time they had to have a special tech person to stand by and keep it going for all the groups… if it got going at all with the many issues. If not then we were left with no group mentor or moderator that was required. Plus, it was put in place to control the issues discussed and to cease any negatives brought up about VA care or staff. Said to keep us on the topic or discussion of the day. Tricky they are.

      Local news reported on robots flipping hamburgers, and pc stuff to do blood tests, with possibles to come for more cancer screenings, etc. We gonna put some fecal matter on a computer test thingy like they do diabetic blood checks next? Well I won’t be doing it for sure… no VA for me again ever.

      There is still the major issues of rural communities not having those cell phone towers in place and connection issues. Major issue here locally and from those in Illinois that used to come here for groups. No money supposedly for such fixes since the state’s are broke or don’t have money for needful improvements like that. Foreigners need that money, the USA doesn’t.

      1. It further isolates patients/stakeholders/Veterans…and since the VA is already doing such a bang-up job at Veteran Suicide Prevention and fails miserably at PTSD, why not just further isolate same patients and drive the daily suicide by indifference by VA tally upward a tad by helping the PTSD isolating along…push….shove…

      2. It further isolates patients/stakeholders/Veterans…and since the VA is already doing such a bang-up job at Veteran Suicide Prevention and fails miserably at PTSD, why not just further isolate same patients and drive the daily suicide by indifference by VA tally upward a tad by helping the PTSD isolating along…push….shove…

    2. @T
      It seems like your group got used as a test to see what will/won’t work (then flushed?). I wish the “heads” would just try to understand how ingrained continuity is in a veteran’s thought processes, especially for those trying to navigate a readjustment that has completely rocked their world. I think part of the benefit of a group in therapy would be the physicality of the group including handshakes and bro hugs along with body language of the members. I’m no therapist but, I have family and friends and I’ve been keen to subtle changes; at times, those can be more telling than words.

      I think group therapy by telehealth can be a big mistake to force on some patients. Conversely, I can see a benefit for some to have the option of an individual patient appointment using telehealth with their assigned therapist, after they have a well-established communication, if that is in part how the program is intended to be utilized. But, that still leaves out some important observations. Veterans are individuals and no longer uniformed robots forced to do and not think past ordered task accomplishment. Veteran healthcare must be tailored to the patient’s needs and not given blanket treatment, as if they all need identical care.

      I agree that the issue of celltowers/wi-fi does need to be addressed, and too, should allow for those with only landline service to have access in that manner. Getting too high tech without giving much thought to those that aren’t tech savvy or without access are both segregating care. As far as the connection problems you mentioned, that could be issues from the facility hub, or the ISP’s upgrading and causing glitches in that process. I know it bites when someone forgets to call before digging and then throwing the whole works outta whack!

      1. Rosie, at one time years back we had some good groups for various things like pain, anger, PTSD, addictions, etc. Helped get a lot of us out of our stuck spots and finding others with the same issues to swap notes and experiences with. Then they shut down many years back then a few popped back up again shortly around 2013 but the old timers or members were not there anymore. Then the new groups closed as well.

        Then as I posted before, we had new problems like with females not wanting any groups with men for anything. By then the groups were gone shortly after and I don’t know what happened to the females wanting everything separate from males. While wanting that “same treatment as men” and equality, or be a part of the men’s world. Then more activism came in to play and distract or create chaos. It just boiled down to more unnecessary nonsense.

        I have many years of volunteer work under my hat plus helping run a recovery club locally. True the one size fits all or blanket treatments or the like doesn’t work for all and it’s a well known fact but the VA and modern medicine must have lost that old timey thought process a long time ago too. I tried to use local establishments to carry on with certain groups for what the VA dumped but there wasn’t the travel pay with it or much interest so I gave that up too. Some were traveling fifty or more miles to group. There also wasn’t any skirts or single VA staff to flirt with and chase… that the staff and those professionals seemed to enjoy and made certain guys…. pets. Some of them still get their pain meds just like before, no issues at all. Odd.

        Many people can’t or will not use group settings. Some make it okay not being so social or on their own… others not so well due to hard-headiness, control freaks, issues, or whatever. It should just be a choice not a toy like the VA used to claim ‘it would look better in our files if we complied and joined groups. Showed we were being active in our care and serious about it.’ paraphrased. So I took them all plus countless groups or events in the civilian world dealing with chronic pain and etc. Never did see a gold star by my name or a pat on the back for being a good little doggy. lol

        As long as the VA has been around like the VSOs there should be everything and anything available to suit each individual vets needs. Nothing new under the Sun and ‘they’ should have seen and dealt with it all by now. If some refuse help or what may help it’s on their own heads. We, nor the VA can force people to live, if they want to die or continue to do what doesn’t work like isolation, playing hermit, if not suitable for it to addictions.

        I think they are just trying push stuff on us too fast and at high prices, and like said, not having the foundations built to provide the services they claim will work for all.

        Here on the border of Indiana and Illinois are things called Illiani projects and part of VA/civilian health care. IL I an’ I. A two state combo deal. Like with groups those living in Illinois that were too far from care there could travel here for care and for groups at the CBOC. Many of them had no cell service where they were at. So even while being broke some of them had to have cell phone service for travel emergencies and keep their land lines too. Then learn computer stuff at old ages and severely disabled or alone. But the VA like businesses wanted everything to go mobile, auto pay, the computer way, or wireless even if it didn’t work well for them.

        My extended family have issues with cell service and they live in some major urban areas over there. The farther out they are the more difficulty or drop zones depending on geography or other interference. A sister can’t use her cell well and living in senior center in Springfield Il. So I guess it’s a toss of the coin. Another had to get a specific cell phone different from what was used here and new phone and service in Texas. Since the old service that was supposed to be good internationally didn’t work at all in Texas or around their base. More odd stuff.

        A niece told me they still have female VA groups over there by Springfield, but they have to do some driving. She is also the one that had to come to Indy just for blood work and knee problems that still don’t make any sense to me at all. But she likes to travel and play social games since she was a army nurse and defends the VA… of course. And was a state worker with VA after her disability. Go figure. lol

        Whatever works for some or many is okay with me. I would like to see no one left out of what they may need, no one truly left behind or pushed aside or ignored.

    3. @T,
      Yea, quite a few years back it did seem like there were a large assortment of groups for almost anything one could imagine; then along came social media. You mentioned the female veterans wanting to have their own groups for discussing issues they want to express. As a woman, I can assure you, there was no version of malice behind wanting gender segregated groups. Regardless of how capable either gender is in the field, the aftermath of emotion to one’s experiences is going to require a completely different range of understanding, if the soul is to be laid open honestly and to gain from the purpose of the group. That the Women’s Veteran Co-ordinator hadn’t seen to having women’s groups in place is astounding to me. It was, in my opinion, irresponsible for the MH department to offer only mixed gender groups and having both genders undergoing additional and unnecessary pressures. I think lack of foresight and thoughtful planning is behind the demise of the groups, and many other things that should have seen success. I’m just going to stop right there.

      I agree that there are too many expensive VA things evolving at the same time. That said, there has also been a severely lax approach over the last decade or so, to upgrading in too many areas. It is shameful to realize all of the waste that has gone on and it’s useless to mourn all of the good that could have been had because of, like you said, lack of foundations.

      1. Rosie, at the time I was listening in at the time the groups referred to was chronic pain and anger management. I’ve attended chronic pain discussions, groups, convention like stuff locally here and in Illinois and many times was the only male there. Funny stuff really when it was reported open to the public, for all, then only females are there. I was asked if I was tough, didn’t blush easy, adult enough to listen to females discussing their issues, possible parts and from some who may be passing on soon. Well duh, “Well yes, don’t know me do ya.” Or be told how strange it was to have a male show up and stay rather than just dropping his wife or girlfriend off. “Men don’t normally care to show or share their pain or emotions with others.” Huh? Okay, jabs taken move on with the program.

        They did of course have their specific groups for sexual things and other issues. I seen no problems or complaints in those like anger groups. That is pretty cut and dried and applies across the board. But we have those locally that demand the coed stuff and all inclusive thinking while others said no. Like the women wanting to do everything we men do or have and be included in everything. Others the total opposite.

        Like other groups or step groups they have their own gender specific groups for obvious reasons and the ‘open’ meetings and groups or conventions. Which are normally broadcast or reported as gender specific, some are not. Of course there are those who just want to create problems or want something, then when offered it’s turned down by the demanding ones, or laughed about like they really enjoyed just stirring some pot of poo in their minds. Not being serious about the issues at all. What fun they must have.

        When the final groups were coming up and tele stuff coming in they (VA) said they were trying to get tele groups all inclusive as possible. Some of our groups had no blacks, females, Asians, Latinos, etc., in them. Things we could do nothing about like someones religions too but seemingly some ‘up there’ were too obsessed to filling in all the pigeon holes they could be politically correct full circle and to pacify whatever group, union, or activist or people out there complaining or wanting to stir up conflict and chaos. We were ‘too white of a group’ too so that didn’t help matters. Seen as evil racist by the big city cliques I guess. Or it would not have even been mentioned but was.

        Strange ugly days we live in.

    4. @T
      Wow! I stand corrected on the departmental portion of my post.
      Yea, strange days indeed!

  8. Meanwhile, right *now* on NPR they are talking at length about how the VA across the USA has been removing/kicking Vets and Family’s off VA’s Caregiver Program…places all across the USA had say 500+ home/family caregiver program participants, now abandoned to down to 13.

    Acting VA Suck says, “…the VA is working on it”….now, this is after Directives were issued, scolding from Congress Critters, and…the VA continues to KICK VETS OFF HOME CAREGIVER PROGRAMS…WTF VA?

    VA Telemedicine WILL NOT replace what this program does to assist Vets and their families. One step forward with the VA means 20 backflips backwards ….all for the Vets.

    Acting VA Suck: Stick that Cerner contract up your ass.

    1. Can’t get NPR and many other news sources here now. Been cut out of satellite and cable programming per county need or want I am told. I must live in a news dry county and censored on top of that.

      Hey, local news showing a robot that could do back-flips. They are really pushing this high tech AI stuff plus robotic surgeries. Now to telemed? I wanna see any of them give me a prostate exam by pc monitor or device. That should be fun.

      First roll-out with my protest signs this morning. No hassles, got some looks, license plate number taken down by a hospital employee who looked like a cop. One compliment from one old gent and said to ‘go for it.’ So things went well so far. Not stopping. They poked the wrong bear and for many years too damn long and from every angle they could. I am calling for the staff activist to be fired and hospital admin (3 MDs) to resign due to ethics, protections under the disability act, HIPPA violations, slander, professional misconduct, etc. And I want to know what the freaking VA put in my files to make me such a hated enemy in the health care field besides not being a non-conformist to our communist regimes locally and state wide. Indentity politics and hating those of us who are not full Demoncrats or neocons, support the local corrupt cliques, or union supporters is the way of things here. Off to rest.

  9. This will save the VA millions by eliminating travel pay to get to the VA clinic or hospital. Private heath providers are also doing this so it is just using an existing method of medical care delivery. I don’t think a nurse is going to practice outside their level of expertise and if the medical situation at hand is more serious, wouldn’t you go the ER?

    I keep saying, the solution to VA medical care is to give the Veterans a card and let him go to the doctor of his choice. Let him get hospital care at the hospital of his choice. Socialized medicine doesn’t work. Private health care does!

    1. According to ones geography, politics, levels of corruption on many levels, to the state or local’s bowing to perpetuate or continue on with VA threats and retaliation… civilian care may vary… greatly. Here I am getting the same level of shit…and much more, than I did when dealing with the VA, their PAs, nasty communications and information games. So we can’t really say what will work for all or may not work. It’s circus and back to rolling the dice.

      Plus the same old stories about some tech issue, platforms malfunctioning, or files not being found continuing on.

      Plus repeating: Civilian MDs or clinics here are not seeing patients that include those with chronic pain issues or multiples of such complaints. Many will not take new patients. They all claim here there is a major shortage of MDs so that is why the need for many more DACA people to get into professional positions and the need for mass immigrants or refugees to help fill all the gaps they claim we have. Transitioning for me from VA care to civilian care is and has been a constant hassle and struggle with no letting up, integrity, positive support in-sight. Yet the illegals, immigrants, refugees seem to be getting whatever the hell it is they need and zoomed into secretive spaces for emergency room care for splinters and births. Oh but that isn’t happening the news or politicians claim.

  10. cj ¯¯̿̿¯̿̿’̿̿̿̿̿̿̿’̿̿’̿̿̿̿̿’̿̿̿)͇̿̿)̿̿̿̿ ‘̿̿̿̿̿̿\̵͇̿̿\=(•̪̀●́)=o/̵͇̿̿/’̿̿ ̿ ̿̿ says:

    Telemed= no more travel pay, parking lots converted to tennis courts, mass layoffs, (downsizing), of course telemed is outsourced to India, why not?, and lottsa more money for the AFGE, whoooo hoooo everyone wins except the Veteran.

    “Shhhhh, it’s not really your doctor, they just put a nice shirt and tie on the resident plumber, wondering why the plumber has Clutch Cargo lips? and an Indian accent?

  11. Useless shit.There is just so much wrong with this that I could get in trouble with.I think i’ll play it safe and shut up. Thanks for the laugh Ben.

    1. “Nex”, you and I have the same train of thought!

      But, again, VA is using veterans as guinea pigs!

  12. “[…“By allowing VA telehealth providers to more easily treat patients across state lines, we can ensure that recent advances in technology-enabled care reach the most deserved among us and spur better outcomes for the 20 million veterans in the VA system today.”…]”–

    Take notice of that catchy phrase^^…”…and spur better outcomes…”…^^

    “Spur”- 1. To affix a sharp cutting instrument onto a fighting gamecock’s leg for cockfighting, 2. To prick or urge on, 3. Without deliberation, impulsively goading-on (hurry-up and wait), 4. To achieve distinction or success the very first time;prove one’s ability or worth, 5. The VA will remain a spur in the ass of Veterans and even moreso with VA Telemedicine where Google Translate will not have a clue what the hacks are saying either.

    “Spur” used in a VA Sentence: “Our Purple Teams have not won their spurs yet”.

    “Better Outcomes”- Google Translate says this means new & improved non-exploding VA bodybags that VA Telemedicine will send each and every Veteran so their spouse or friends can simply mail-in the deceased Veteran to your local VA Better Outcome Intake Center.
    (postage not included until next congress critter cash grab and approval of USPS Union…all for the Vets)

  13. OT food for thought: “” Never forget what they want you to forget, then ‘they’ do it all over again.

    Rural medicine or access to it is a problem? The fix is to go high tech when they are constantly complaining about not having signals or good connections to the net by by satellite, having no cable services, no signal or drop zones?

    It also brings up more of those security issues and too many having access to our information we are not aware of, or some political activist can easily get from their office. Who knows?

    It’s difficult enough now to check health care workers degrees, specialties, training or graduated bottom of their class… or can’t comprehend English or little command of it. Or the need for a tech to translate what is trying to be relayed or spoken about. They may not speak… hick, townie, or country.

    They fail to mention little factoids like the requirements of having written prescriptions for something and the having to go inside to sign forms to pick up various meds at a pharmacy. For that ‘community care, if not using the VA pharmacy or care. And… will all vets be treated the same or be cherry picked for more VA hassles or retaliation?

    Which is it. For years the need for social conditioning, physical meetings, groups, socializing, getting out and meeting others were top of the list for care. Now it is all going ‘virtual’ with no or little physical contact with others? Oh it’s a magical cure all!

    As with all things some may benefit from all that ‘change’ and high tech aids, others not so much. Many years back they’ve used this stuff to monitor heart issues, BP, etc. Guys said it was fantastic and made them feel more safe and connected to care. Imagine this: A few heart patients said they had the same heart MD at the VA for over twenty five years, loving the high tech stuff, imagine that. What good will it do when they are called in for more testing, cleared, no problems, then have a major heart attack just after? Was it a blip or was heart attacks brought on by shoveling snow to get out for a long drive, or locally, or the heat, waiting or traffic jams. Stress from dealing with idiots. Who knows. Throw the dice.

    “The Veteran establishes a relationship with a go-to person that is essential for the Veteran’s overall health care plan and personal health goals.” VA or civilian… how funny is that. Great propaganda and facade, not reality.

    “case management and personal connection” They can’t manage much now and seriously lack bed-side manners and have those robotic like personal connections and VA or Med-speak. Hell-o we are the VA or so and so and we are here to help blah blah. Virtual personal connections now. How about some sex some of them tell us we need, or dates? Ha ha. Imagine those computer attachments or ‘algorithms.’ And the voyeurs.

  14. REALLY simple fix.

    Every single time you are unhappy with a telehealth session and find out that it violated state laws you simply file a complaint against the doctor with the state licensing agency. You cite the laws being broken at the State level, how it harmed you or others, and notify everyone there is within your state who deals with physician licensing and such of the deviation from state law.

    The only license board that can not touch a VA care provider is the pharmacy liceninsing boards. All social workers, nurses, doctors, and other such folks ALL answer to their reapective boards for licensure who are in no way bound by VA policy or decision. Do not turn VA in. Turn the doctors I. How knowingly violate state standards to the state medical licensing boards. It is there that the they can explain why they are protected from following established legal protocols as is expected and demanded by their licensing agenies.

    It will only take a few license violations before VA docs figure out VA can only protect them from government accountability and can in no way shield them from professional accountability when they knowingly violate state law.

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