The VA decision would remove a financial barrier when a veteran's physician wants to have a specialist remotely examine the patient in a VA clinic or hospital. More importantly, the move signals an expansion of the VA's decade-old program to use teleheath to keep ailing veterans at home and out of hospitals and nursing homes.
According to the VA's proposed amendment to its regulations, the elimination of the copayment "would remove a barrier that may have previously discouraged veterans from choosing to use in-home video telehealth as a viable medical care option. In turn, VA hopes to make the home a preferred place of care, whenever medically appropriate and possible."
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The VA's home telehealth program began in 2003 with telemonitoring of patients who had diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and/or depression. While those remain the core conditions in the program, the VA recently contracted with American Well to supply video home telehealth programs for behavioral health, oncology, and post-operative complications. In these and other VA programs, providers use videoconferencing to examine patients. The VA also offers interactive voice response and home monitoring devices, where appropriate, to collect clinical data.
Although the copay proposal makes clear that the VA is trying to increase veterans' access to care, especially in rural areas, the department also states that cost control is part of its motivation. "Telehealth helps ensure that veterans are able to get their care in a timely and convenient manner, by reducing burdens on the patient as well as appropriately reducing the utilization of VA resources without sacrificing the quality of care provided."
A recent study in the VA's Northwest Health Network showed that home telehealth saved the division $742,000 last year, including transportation costs. And a 2008 VA study found that the use of home telehealth reduced hospital bed days by 25% and cut hospital admissions by 19%.
The Partnership for Quality Home Healthcare, an association representing 1,500 home care agencies, praised the VA's proposal. "We applaud the VA for recognizing that copayments can shift patients to more costly settings and increase healthcare costs," stated former Louisiana congressman Billy Tauzin, an attorney for the association, in a press release. "By eliminating this counterproductive barrier, the VA is making it possible for more veterans to receive clinically advanced, cost-effective care in their own homes."
Roy Schoenberg, MD, president and CEO of American Well, told InformationWeek Healthcare that the VA's elimination of copays for video telehealth shows that the VA is encouraging veterans to be treated at home. In addition, he noted, the VA is setting a key precedent for the rest of the U.S. healthcare industry. "The VA is taking a stand that they need to move as much of healthcare into patient homes as possible," he said.
Some private insurers cover telehealth and reimburse physicians for it, Schoenberg noted. "But none of them has gone as far as the VA in saying that telehealth is now a preferential mode of treatment and we're going to incentivize the use of it, because it is of strategic importance to us in reforming healthcare delivery."
Using home telehealth in the first 30 or 60 days after hospital discharge, said Schoenberg, can greatly reduce post-operative complications and readmissions. Moreover, he pointed out, most cancer patients remain at home during their treatments, and a lot can go wrong during that period. "The ability to keep managing that patient in the home environment during their cancer therapy by using telehealth changes the nature of follow-up monitoring and the ability to intervene."
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