VA reports big wins through telehealth

600K veterans receive telehealth services in 2013.
By Eric Wicklund
09:53 AM
Omaha VA Medical Center in Nebraska Photo: VA Health, 2010
Despite the bad press the Department of Veterans Affairs has received in recent weeks, officials are seeing marked success from their telehealth programs, which have enabled the agency to treat more veterans, reduce hospital admissions and save some serious money. 
Among the more notable findings the VA shared in a new report are that home telehealth services reduced bed days of care by 59 percent and hospital admissions by 35 percent in 2013, while clinical video telehealth services reduced bed days of care for mental healthcare patients by 38 percent. In terms of savings, the VA's chief consultant for telehelath, Adam Darkins, MD said home telehealth reduced healthcare costs by roughly $2,000 per person per year, while clinical video telehealth saved roughly $34.45 per consult and store-and-forward telehealth saved roughly $38.81 per consult in travel costs.
Darkins calls telehealth one of the VA's "major transformational initiatives, one aimed at making care convenient, accessible and patient-centered." And his report makes the case for continuing and expanding these services, particularly at a time when the agency is plagued by serious problems at its brick-and-mortar facilities.
More than 600,000 patients – or 11 percent of the nation's veteran population – received some form of telehealth in 2013 from the VA's network of 151 medical centers and 705 community-based outpatient clinics, according to Darkins, and that number is expected to grow annually at a rate of 22 percent. Of that number,  45 percent live in rural areas and might not otherwise have been able to receive needed care, Darkins added, and of the more than 144,000 veterans enrolled in home-based telehealth initiatives in 2013, some 40,000 were able to use those services to live independently, thus avoiding long-term institutional care.
Darkins also pointed out two growing trends: Telemental health, which was established as a program by the VA in 2010 and was used in 2013 by more than 1,000 veterans suffering from a wide range of issues, including post-traumatic stress disorder; and chronic disease management via home telehealth, which supported more than 7,400 patients in 2013.
The growing value of telehealth isn’t without its challenges, however. Darkins pointed out that telehealth training isn't offered in most medical schools, and that the more than 60 requirements for establishing new telehealth programs are beyond the abilities of most VA staff, forcing the VA to train its own providers as they go. He also noted that telehealth programs require extensive technology support, and while the Joint Commission doesn't survey healthcare institutions specifically for telehealth, it can target poor programs during so-called "Tracer" reviews, exposing the VA to questions about its overall telehealth management practices.
Still, Darkins sees a lot of value in telehealth going forward.
"Telehealth in (the) 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,'" he concluded. "The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one."