AcuteCare Telemedicine Blog


Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.



Why the VA is a Leader in Advancing Telemedicine

Initially used to reach those who live in rural areas, telemedicine is quickly expanding its reach into every area and genre of medical care delivery.

Interestingly, when the history of telemedicine is written, significant credit for hastening the advancement of telemedicine will go to a government health care agency that is not always credited with innovation and exemplary delivery of patient care and service.  The Department of Veterans Affairs (VA) is successfully deploying telemedicine on a large scale. In fiscal 2013, more than 600,000 veterans accessed VA care using telemedicine programs, for a total of more than 1.7 million episodes of care. The reach of VA’s telehealth services is growing at 22 percent a year. The agency is currently in the midst of a pilot program that allows veterans to enter vital information into an online tool that is accessible via mobile phones, tablets or desktop PCs to help their caregivers manage chronic conditions. The VA is launching another service that allows larger, better-resourced hospitals to connect with smaller facilities to provide remote support for intensive care.

“The VA did not get into telemedicine out of an inherent interest in technology”, said Dr. Adam Darkins, who leads national telehealth programs at the agency. Rather, VA officials wanted to help aging veterans with chronic disease live independently, for clinical and financial reasons. Although the VA has a network of 152 hospitals and more than 1,100 other caregiving facilities, it still faced the problem of having to cover a lot of territory in terms of reaching veterans. Additionally, officials found that 45 percent of those requiring treatment resided in counties classified as rural by the U.S. Census Bureau.

One big reason the Administration has been able to lead in the expansion of telehealth is attributed to its network of physicians who are able to treat veterans throughout the system without regard to state licensing rules, an advantage that private medical industry practitioners do not enjoy. The growing telemedicine industry is still working toward standardization and interoperability but the biggest impediments to the rapid expansion of telehealth remains state licensing and regulations that restrict treatment by out-of-state doctors.

Congress is beginning to take necessary legislative action to resolve many of the issues that are slowing telemedicine advancement in the private sector. The Telehealth Modernization Act, a companion bill backed by Reps. Bill Johnson (R-Ohio) and Doris Matsui (D-Calif.), would create a single, federal standard for telemedicine for use in national health care programs. And the Telehealth Enhancement Act from Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) would expand reimbursement for telemedicine services under Medicare and Medicaid. It would also amend the Communications Act to support health care providers under the universal service requirement.

It’s not clear if any of those bills will pass, but the bipartisan focus on expanding telemedicine on that powerful committee indicates an interest in establishing some federal rules to make the patchwork of state laws more manageable for providers and insurance carriers. The VA has certainly provided an example of leadership as legislators clear the way for advancing the use of telecommunication technology in delivery medical care.



The VA Is Leading The Federal Charge On Advancing Telemedicine

Two California Congressmen have submitted a bill that would expand telehealth coverage to active-duty service members, their dependents, retirees and veterans.  The 21st Century Care for Military & Veterans Act (H.R. 3507) was submitted earlier this month by U.S. Reps. Mike Thompson (D-Calif.) and Scott Peters (D-Calif.). Co-sponsored by Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) and endorsed by the American Telemedicine Association, the bill would establish and expand current reimbursement policies for telehealth coverage under the Veterans’ Administration (VA) and The Defense Department’s TRICARE.

The VA has seen a 40 percent reduction in bed days and 87 percent reduction of annual per-patient costs when compared to home-based care programs, according to VA studies. Adam Darkins, MD, the VA’s chief consultant for telehealth services, anticipated that some 825,000 veterans would be served through telehealth by the end of 2013.

This new bill will offer members of the Armed Forces and their families the highest quality healthcare in a timely manner no matter where they live or how far away they are from the doctor they need to see. Technology can create a responsive and more efficient healthcare system that provides for better care and lower costs.

Earlier this year, U.S. Rep. Devin Nunes (R-Calif.) joined U.S. Rep. Frank Pallone (D-N.J.) in sponsoring the Telemedicine for Medicare (TELE-MED) Act (H.R. 3077), which would enable healthcare providers to treat Medicare patients in other states with telemedicine tools and services but without needing a different license for each state.

The VA, which launched telehealth services in 2003, appears to lead the way for the rest of the federal healthcare bureaucracy by eliminating many, still well-entrenched, barriers to the rapid expansion of telemedicine technology.  Given the history of the VA’s percieved poor performances in delivering much needed traditional healthcare services to our veterans, their leadership in advancing the use of telemedicine is a trend that is more than just a little encouraging.



The VA Using Telemedicine to Expand and Improve Care to Veterans

The Veterans Affairs Department (VA) is changing the way it delivers health care to more than 8 million veterans.  The bureaucracy that has been struggling recently to provide services to more than 500,000 new beneficiaries, and who have demonstrated persistent difficulties in getting new veterans signed up for benefits, appears to be ahead of most health care providers in using technology to improve patient care.  The VA is now deploying a host of applications to expand its reach and make it easier for veterans to get care, no matter where they live.

The new mobile apps are rapidly changing how veterans access the resources and information that is available to them by engaging caregivers outside of the traditional office visit. Veterans can receive care through a telehealth program which uses Scan-Echo, a technology used to gather multiple care givers together to recommend a particular treatment plan. These technologies are helping create a system of care without walls, a virtual system of care.  The VA is making a huge investment in telehealth technologies, spending $500 million in 2013 alone on telehealth services, which include telemental health, telehome health and clinical consultation by video. Robert Petzel, VA’s under secretary for health, says, “This is where medicine is going, the virtual care delivery system.”

The VA has nine different technologies currently in use or about to enter the pilot stage which can perform functions like renew medications, communicate with their provider, look at their medical record information, such as labs, progress notes and radiology reports. A patient can utilize their iPad or smart phone to reorder medications or obtain other medical information on the spot.

The app is focused on giving veterans the knowledge to make better decisions and improve their quality of life.  It features a set of questions about the patient’s health history that, when answered, produces a summarized, personalized assessment of their current health status, their risk of major diseases, and the impact of their various choices will have on their health. The assessment calculates the risk of developing major disease, such as heart disease, stroke and diabetes so that the veteran can choose to change his or her lifestyle and recalculate the risks to see the impact those changes would have.  The VA developed the health living assessment program in response to both veterans’ and providers’ desire to have more tools.  Currently about 17 percent of all veterans are using telehealth services but it is estimated that 66 percent of all veterans could benefit from the technology services.



VETS Act Expands Veterans Access to Care

A bi-partisan bill, introduced by Representatives Charles Rangel (D-NY) and Glenn Thompson (R-PA) and cosponsored by 21 Members of Congress, would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. The bill, known as the VETS Act, builds on the unanimous congressional enactment of the 2011 STEP Act (Servicemembers’ Telemedicine and E-Health Portability Act,) which provides a similar provision for healthcare providers in the U.S. Department of Defense. A similar licensing rule for patients and providers of Medicare, Medicaid and other major federal health programs was included in a comprehensive telemedicine bill submitted by Rep. Mike Thompson (D-CA) in December 2012.

These bills are a simple way, while preserving the states’ role to license, to address shortages of medical specialists, to improve patient access to the best qualified physicians, and to accommodate mobile Americans and multi-state health plans,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association.  Currently, most providers who practice interstate telemedicine must be licensed both where the patient and provider are physically located. In some states, medical boards are even imposing stricter licensing requirements for telehealth providers than they do for in-person care, such as requiring a prior face-to-face examination for each and every case.

The Veterans Administration is consolidating many medical specialties in regional facilities that are often located a considerable distance from veteran patients who need regular treatments for injuries suffered in the defense of the country.  In some cases these patients need to travel into another state to receive specialized care, resulting in significant inconvenience and expense to VA beneficiaries.  The ability to treat these patients across state lines by use of telemedicine technology promises considerable benefits to patients and the VA care providers.

For the Veterans Administration who is currently experiencing a backlog of more than 500,000 requests for benefits, removing or lowering regulatory barriers will surely enhance the accessibility of care for patients living in areas remote from VA treatment centers while generating operational efficiencies for the VA.



Medicare Recipients to Lose Telemedicine Services Benefits

Even though the availability of telemedicine has proven its value by lowering costs, increasing access and improving treatment and remote monitoring for chronic diseases, thousands of Medicare beneficiaries will soon lose access to telemedical services simply because of where they live, or more accurately stated, how government statistics identify where a patient lives.

Medicare patients from Hawaii to Puerto Rico to Minnesota will be redefined as living in “metropolitan” areas, precluding them from receiving Medicare coverage for video conferencing and other telehealth activities, even though 80% of beneficiaries live in urban counties such as those cut from the list.

“Congress has long overlooked the need for telemedicine services for residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare.  Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” said Jonathan Linkous, CEO of the American Telemedicine Association.

Originally, telemedicine technology demonstrated its most obvious benefits to rural communities, where specialized and chronic medical services and treatments were often not readily available without significant cost and inconvenience to patients.  However, the same cost/availability benefits have proven to be just as effective in urban areas and when chronic illness and extended, after hospital, care is encountered.

A study provided by the Commonwealth Fund shows that telehealth consultations are effective in reducing the amount of time patients spend in the hospital for care of chronic illnesses.  By examining data from large telehealth programs run by the Department of Veterans Affairs (VA), Partners HealthCare in Boston, and Centura Health, based in Colorado, researchers found that home monitoring programs can cut costs and raise patient satisfaction up to 85%.  Under the new guidelines, Medicare coverage will not be available for telemedicine visits to beneficiaries living in metropolitan areas–where over 80% of recipients live, resulting in cost reductions for the Medicare program.  Correcting this oversight will require an act of Congress, another incident of bureaucratic, regulatory interference with beneficial advancements in the delivery of healthcare to patients all around the country.

Given the increased involvement of government in the total delivery of health care in the coming years, this lack of insight does not bode well for reducing costs and improving availability to those who are most in need of the best in healthcare services.



The VA Deploys Telemedicine and Telehealth Programs

The Department of Veterans Affairs  (VA) has released a comprehensive 400-page report that outlines its successes last year in the effort to improve veterans’ access to quality healthcare, including the implementation of an extensive telemedicine program. The report concludes that the use of telemedicine and telehealth has significantly improved veterans’ access to quality healthcare, and quality of life, by reducing the amount of time and travel needed to receive care.

The news is particularly encouraging given the performance level of the federal agency that is charged with providing ongoing medical care for millions of our nation’s military veterans.  Veteran Hospitals (VA Hospitals) have historically been located near large metropolitan areas, requiring patients to travel long distances for even the most basic of medical services.  The agency is making significant changes to its system, consolidating specific treatment into regional locations, causing some patients to be concerned about traveling even longer distances to receive their VA Medical Benefits.

Most recently the Agency has come under attack for its inability to process a long backlog of claims resulting in some veterans who have been waiting for treatment to coin the phrase, “Delay, Deny, and Wait Till I Die”.  Embracing the new telemedicine and telehealth technology programs may be the most promising decision the agency has made in the recent past to help turn the long history of inefficiency and questioned quality of care around.

The Department of Veterans Affairs (VA) 2012 Performance and Accountability Report, submitted by Secretary of Veterans Affairs Eric Shinseki in November, discusses the Department’s achievements in improving healthcare and benefits service delivery to veterans.  The report states that in 2012, the VA maintained the largest integrated healthcare system in America and implemented “new innovative practices to improve Veterans’ access to health care, such as telemedicine and mobile clinics, to provide care to more than 6 million unique patients.” Throughout 2012, nearly 500,000 veteran patients received 1.4 million telehealth-based consultations, which were delivered from 150 VA Medical Centers and 750 Outpatient Clinics.

Supporters of the VA’s utilization of the latest technologies to expand access to quality, primary and specialty care believe that it will transform healthcare delivery at VA Medical Centers while providing veterans solutions that enable greater access to their benefits, at a lower cost, all while improving the quality and outcomes of the medical care.

Telemedicine and telehealth technology is demonstrating its benefits of improved care, increased access and lower costs in the private sector.  Let’s hope that its application and practice at the VA demonstrates an equal measure of success.  Our military members risked their lives and suffered countless injuries in service to our country.  They deserve efficient, accessible, quality medical care for their commitment and sacrifice for protecting our freedoms and our country’s security.