VA to eliminate co-pays for telehealth consultations

WASHINGTON — The Department of Veterans’ Affairs has long been an advocate of using telehealth to reach veterans in their homes. Now it is working to make adoption easier and more appealing by fast-tracking a proposal to eliminate patient co-pays for in-home video telehealth consultations in its Home-Based Primary Care (HBPC) program.

The VA had published a proposed rule in March to eliminate the co-pays, then added a direct final rule that would expedite the process if the proposed rule received no “significant” opposition. With the comment period ending on April 5, the rule could go into effect as early as May 7.

The HBPC program was created in 1972 to serve veterans with chronic conditions, focusing on a home-based approach to providing healthcare. According to a presentation at the 2011 National Health Policy Forum, the program has reduced hospital days by 62 percent and long-term-care days by 88 percent, thus reducing total healthcare costs by roughly 24 percent.

“Telehealth allows VA to provide certain medical care without requiring the veteran to be physically present with the examining or treating medical professional,” the direct final rule states. “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. The benefits of using this technology include increased access to specialist consultations, improved access to primary and ambulatory care, reduced waiting times and decreased veteran travel.

“Like clinical video telehealth, in-home video telehealth care is used to connect a veteran to a VA healthcare professional using real-time videoconferencing, and other equipment as necessary, as a means to replicate aspects of face-to-face assessment and care delivery that do not require the healthcare professional to make an examination requiring physical contact,” the rule continues. “However, in-home video telehealth care is provided in a veteran’s home, eliminating the need for the veteran to travel to a clinical setting. Using telehealth capabilities, a VA clinician can assess elements of a patient’s care, such as wound management, psychiatric or psychotherapeutic care, exercise plans and medication management. The clinician may also monitor patient self-care by reviewing vital signs and evaluating the patient’s appearance on video.”

The Partnership for Quality Home Healthcare has come out in support of the action, saying it “would remove a barrier that may have previously discouraged veterans from choosing to use in-home video telehealth as a viable medical care option.”

“We applaud the VA for recognizing that co-payments can shift patients to more costly settings and increase healthcare costs,” said Billy Tauzin, chairman and senior counsel to the organization, in an April 5 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.”

In its ruling, the VA indicated it would not exempt co-pays for clinical video telehealth services, usually undertaken at community-based outpatient clinics, because they involve medical specialists, staff and technology outside the clinic, and because patient interaction plays an important part in these encounters.

The VA has seen a direct ROI in its telehealth program. According to officials, the Northwest Health Network, also known as the Veterans Integrated Service Network 20, which serves Alaska, Washington, Oregon, most of Idaho and a small part of Montana and California, saved roughly $742,000 in 2011 through the use of telehealth in more than 23,000 patient encounters, while one provider, the VA Roseburg Healthcare System in Oregon, saved more than $88,000 in travel costs by shifting more than 3,200 patient encounters to telehealth from in-person visits.

In addition, last November, the agency contracted with Boston-based telehealth provider American Well to make the company’s Online Care system more accessible to veterans. The contract, awarded after American Well earned the top prize in the VA Innovation Initiative (VAi2) industry innovation competition, allowed the company to establish three online practices to help veterans — a behavioral health practice in Minnesota and an oncology practice and perioperative practice in Nebraska and western Iowa.