For all of its administrative challenges in providing essential healthcare, the Department of Veterans Affairs has been recognized for its successes in delivering telemedicine to reach rural and remote patients who might live hours from the nearest VA facility.
But it could do more.
Officials from the VA recently made their way to Capitol Hill to appeal for legislation that would grant the agency greater flexibility in providing remote health services to the military community. In particular, the VA is putting a "special emphasis" on improving the delivery of health services for veterans in rural and "underserved" areas, according to Dr. Kevin Galpin, executive director of telehealth services at the Veterans Health Administration.
"Telehealth is mission-critical to the future of VA healthcare," Galpin told members of a Senate appropriations subcommittee, adding that the "potential to expand access and augment services is both vast and compelling."
"But to make this transition, the VA must operate in an environment that supports the type of advanced healthcare and service that these technologies enable us to provide," Galpin said. "This is where we need the help of Congress and a unified government that is fully aligned and working to fulfill our commitment to veterans."
Seeking cross-border authorities
Galpin's primary request is relatively straightforward. He is asking Congress to expressly affirm that VA providers are authorized to deliver telehealth services across state lines and to patients in their homes.
"This authority will remove barriers that currently exist between a national VA clinical expert and a veteran that needs their service," he said.
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With that authorization, the VA anticipates that it could improve the quality of care in rural and remote areas, and be better positioned to hire leading doctors who might be drawn to the flexible work environment. Additionally, the agency sees telemedicine as an opportunity to expand its menu of services without having to commit the capital resources to build a new physical facility or expand an additional one.
"This requires transitioning from a healthcare delivery model that has been in place for decades, with a dependence on in-person care delivery to a system that leverages modern technology to provide veterans, their families and their caregivers virtual access to VA teams when clinically appropriate," Galpin said.
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Among the members of the subcommittee, there was broad agreement on the potentially transformative impact of providing services remotely, inviting the prospect of delivering higher-quality care more quickly and at lower costs. Sen. Brian Schatz (D-Hawaii) singled out the military community for its early successes in the field.
"Telemedicine has the potential to revolutionize the quality, convenience and cost-effectiveness of healthcare in this country in general, and for veterans in particular," Schatz said. "And the VA and DoD have been real leaders in this."
Looking to expand delivery of telehealth care
The VA has three broad categories of telehealth services, comprised of clinical telehealth, home telehealth, and "store and forward" services, where a device captures an image and relays it along to be examined by a specialist at a later time.
The VA offers telehealth services in more than 50 clinical specialties. The VA reports that more than 307,000 veterans received care through a clinical telehealth encounter last year, and, at present, more than 87,000 are using home telehealth services.
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Nonetheless, telehealth remains a relatively small piece of the VA's overall healthcare operation. Last year, more than 5.8 million veterans received VA care, but of those, just 12 percent engaged in some kind of telehealth activity.
The agency is looking to increase that figure in the coming years, building out access to services and beefing up capacity by hiring specialists in metropolitan areas who could remotely administer care to veterans in rural and far-flung locales.
But the agency insists that Congress must put it on clear legal footing for those expansion plans to materialize.
"As a first step and very simply, we need clear legislative authority from Congress authorizing our VA providers to care for a veteran, irrespective of the location of the provider or the veteran," Galpin said.
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