The Department of Veterans Affairs (VA) expanded telemedicine options significantly in 2014.
During the 2014 fiscal year (which ran from October 1, 2013 through September 30, 2014), the VA served more than 690,000 veterans via telehealth. This represents about 12% of the veterans enrolled for VA healthcare, and in total, more than 2 million telemedicine visits took place in FY2014. The majority of patients participating in telemedicine VA visits (55%) lived in rural areas with limited VA access for care. Veterans Affairs Secretary Robert A. McDonald has said that telemedicine has been identified as a growth area for the VA in coming years.
This year, a VA reform bill signed last August authorizes accelerated deployment of mobile VA clinics outfitted with telemedicine gear so that veterans don’t have to travel long distances to receive the medical services they need. It will also reduce wait times for accessing care. The results include not only better care for veterans, but lower costs to the VA: annual healthcare costs for veterans treated through telemedicine fell by 4% in the year following their first telemedicine visit. Here are some of the ways telemedicine is being tapped more for veterans.
Telemedicine on Wheels in New England
The combination of veterans coming home from deployment and needing medical attention and the aging of Vietnam veterans is putting strain on the VA healthcare system. One way the agency is addressing the situation is by using telemedicine to improve access to care. The VA Medical Center in White River Junction in Vermont recently gave a demonstration of a mobile clinic consisting of a van filled with the latest technology, in order to show people how telemedicine works.
Inside the van are special cameras designed for throat exams as well as a range of instruments for performing tests like hearing assessments. When these devices are used, the results are instantly transmitted to the appropriate doctors and are also filed in patient records immediately and automatically.
Physical Therapy for Veterans via Telemedicine
The VA clinic in Newport, Vermont now offers physical therapy services by telemedicine, through a connection similar to Skype. One of the difficulties with physical therapy for people who have mobility issues, or who undergo surgery is that simply driving to physical therapy appointments can be a big challenge. For some, like people with amyotrophic lateral sclerosis (ALS), transportation can be an even bigger obstacle. These veterans can actually have telemedicine equipment installed in their homes so they can receive physical therapy without worrying about transportation.
While other physical therapy patients may not have access to services in their homes, they do have the option of going to a clinic close to where they live so they don’t have to face a long drive to have physical therapy. This makes it easier to seek care earlier and attend appointments, both of which have positive effects on health outcomes. In the White River area alone, nearly 7,000 veterans participated in telemedicine in 2014.
Home Telehealth Monitoring for Veterans with Chronic Conditions
For veterans with chronic health conditions like pulmonary disease, depression, heart failure, or diabetes, telemedicine can take some of the complexity and inconvenience out of receiving medical monitoring and care. When older or more disabled veterans are unable to receive the care they need, they can face losing their independence and having to move to a nursing facility so their condition can be monitored frequently.
Fortunately, new technologies are making it possible for many of these veterans to be monitored from the convenience of their own homes. Devices that check vital signs and transmit the results to VA medical personnel can be installed in veterans’ homes using regular phone lines, modems, and mobile phones. The systems are operated by an interactive voice response (IVR) system. These devices can help veterans live independently for as long as possible and still receive the monitoring necessary for ensuring they receive the care services they need.
Telemedicine and Treatment of PTSD
Veterans with post-traumatic stress disorder (PTSD) often have difficulty obtaining and attending therapy, particularly if they live in rural areas. Telemedicine, however, can help with care access and make it more likely these veterans will follow through with the counselling necessary to help them heal, counselling that may need to take place over several months.
A VA-funded study published in JAMA Psychiatry of 265 rural veterans with severe PTSD reported encouraging results from counselling delivered via telemedicine. A control group of veterans seeking care in person at VA centers and outpatient clinics run by the Veterans Health Administration were less likely to complete eight or more sessions of therapy, which is considered a minimum for effective treatment of PTSD. The telemedicine group not only stayed with their therapy longer, they showed greater improvement in their symptoms of PTSD and depression.
In 2012, more than 1.3 million veterans received behavioral healthcare at VA facilities, an enormous increase over numbers for 2006. Anywhere from 25 to 30% of the nearly 3 million troops who served in Iraq and Afghanistan are believed to have PTSD, and suicide rates among veterans remain high even today. Telemedicine is one key to helping vets who need help get it and have the means to stay with treatment long enough to improve success rates.
Legislation to Expand Telemedicine Services to Veterans
The VA has been very forward-looking as far as implementing telemedicine. One of the major issues hindering expansion of telemedicine in the civilian population has to do with licensing of physicians, who are licensed on a state-to-state basis. The VA allows its VA facility doctors from any state to treat any veteran in a VA facility in any state without worries about licensing. A bill introduced in Congress last spring could expand telemedicine to veterans even more.
The Veterans E-Health and Telemedicine Support Act of 2015 was introduced by congressional representatives Glenn Thompson (R-PA) and Charles B. Rangel (D-NY). This proposed law would allow qualified health professionals to practice telemedicine across state boundaries within the scope of their authorized federal duties, even if they are not located at a federally owned facility (as is required now). It will allow veterans to receive telemedicine treatment from anywhere, and not just VA facilities.
The VA has shown leadership on the federal level in expanding telemedicine access to help veterans receive necessary medical care at lower cost, with greater convenience. Studies so far of telemedicine’s effectiveness in meeting healthcare needs of veterans have been encouraging, and could prompt civilian sector healthcare providers to embrace telemedicine more enthusiastically, helping cut costs and improve care delivery for millions of ordinary Americans.
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