The Senate Committee on Veterans Affairs on June 16th held a hearing to discuss current Department of Veterans Affairs healthcare services provided in rural areas. Robert Jesse, M.D., PhD, Acting Principal Deputy Under Secretary for Health at the Veterans Health Administration, appeared before the Committee to describe how telehealth is helping veterans in rural areas. According to the VA, between 30 and 50 percent of telehealth activity in the VA supports veterans in rural and highly rural areas with ongoing growth anticipated.
Currently, the VA has introduced quality management programs for Clinical Video Telehealth, Care Coordination Store-and-Forward (CCSF), and Coordinated Care Home Telehealth (CCHT). Dr. Jesse pointed out that in FY 2009 quality management programs related to telehealth were combined for all three areas to create a single assessment process.
He reported that real-time video conferencing was provided to more than 37,000 veterans in rural and highly rural areas in FY 2008. The majority of real-time video conferencing services were for mental health conditions, but the veterans also used video conferencing for rehabilitation, speech pathology, polytrauma, and spinal cord injury care. In FY 2009, 21,603 veterans received telemental health services in rural areas with 1,600 in highly rural areas.
As reported at the hearing, veterans are faced with mental health issues and need treatments requiring coordination and treatment. The VA is optimizing its Polytrauma Telehealth Network to facilitate provider-to-provider and provider-to-family coordination, as well as to enable consultations from Polytrauma Rehabilitation Centers and Network Sites to reach other providers and facilities. Currently about 30 to 40 video conference calls are made monthly across the network sites to VA and DOD facilities.
To further to treat veterans with mental health issues, the VA is establishing a National Tele- Mental Health Center to coordinate telemental health services nationally with the emphasis on making specialist mental health services such as PTSD and bipolar disorders available in rural areas.
CCSF also known as store and forward telehealth involves the acquisition and interpretation of clinical images for screening, assessment, diagnosis, and management. These services in FY 2008 were provided to 61,776 veterans in rural areas and 2,911 in highly rural areas, however, in FY 2009, this workload increased by 86 percent.
CCSF services were predominantly used to screen for diabetic eye disease using teleretinal imaging. In the last fiscal year, the VA offered teleretinal screening at 283 sites, 78 of which were in rural or highly rural areas but today the VA has 310 participating sites with 84 in rural or highly rural areas. The remainder of CCSF activities covers teledermatology. The VA has a teledermatology pilot program scheduled to expand nationally to five VISNs in 35 sites, 20 of which are in rural areas.
As Dr.Jesse pointed out, the VA is working hard to help veterans continue to live in their own homes with the VA’s CCHT program coordinating and providing services. Currently, 41,000 veterans receive CCHT for non-institutional care, chronic care management, acute care management, and for disease prevention.
Thirty eight percent of these patients live in rural areas with two percent in highly rural areas. The funding for FY 2009 helped the VA increase the delivery of care via home telehealth by 19 percent and today the VA is seeking to further increase delivery of these services by 20 percent in FY 2010.
To help in home care, new Polytrauma Telehealth Network Initiatives are in development and one initiative includes using home buddy systems to maintain contact with patients in rural or highly rural areas with mild TBI, veterans with amputations, and veterans in the need for remote speech therapy.
The VA has developed a Telehealth and Home Care Model as described in the President’s FY 2011 budget submission. The VA’s goal is to develop a new generation of communications tools to include social networking, micro-blogging, text messaging, plus self management groups to provide more care in the home.
Looking ahead, the VA is addressing weight issues among the veterans. The plan is to implement a “Managing Overweight and/or Obesity for Veterans Everywhere” (MOVE) program within the CCHT program to expand groundbreaking programs for weight management.