With COVID-19 Cases Still Climbing, VA Seeks to Improve Telehealth

Kimberly Braswell, a nurse practitioner in the cardiology unit at the James A. Haley Veterans’ Hospital in Tampa, FL, can communicate with patients through a smartphone, computer or tablet to monitor their health. Photo from April 16, 2020, Vantage Point blog

WASHINGTON — While the number of COVID-19 cases being actively treated at VA facilities declined, the total number of infections and deaths rose steadily in July and August.

Between July 27 and Aug. 21, VA added another 10,000 COVID-19 cases, bringing the total number of cases in the pandemic to 48,495. By Aug. 21, the total number of veteran deaths was 2,545, with approximately 420 of those coming in the three weeks prior. 

With VA officials expecting another surge in infections and deaths this fall, the department relies increasingly on telehealth and other technology to help provide care while keeping veterans safe. 

In 2019, VA oversaw two million episodes of telehealth care. In the first half of 2020, the department has already overseen nine million episodes. Not all veterans have access to the kind of high-quality internet that allows for videoconferencing with providers, however. Rural veterans and those on tribal lands are especially at risk of not being able to access this type of care.

“As of 2019, rural veterans make up approximately one-third of VHA enrollees and are on average older than their urban veteran peers, tend to experience higher degrees of financial instability and often live with a greater number of complex health needs and comorbidities,” explained Sen. Jerry Moran (R-KS) at a Senate Committee on Veterans’ Affairs hearing last month. “For rural and tribal veterans, the geographic barriers to VA care often go hand-in-hand with poor or nonexistent connectivity to the broadband necessary for high-quality care via telehealth.” 

A recent Federal Communications Commission report found that approximately 19 million Americans do not have access to high-speed internet. Of those, 14.5 million live in rural areas, accounting for 25% of the country’s rural population. In tribal areas, one-third of the population lacked access.

“This is a critical issue for us,” Kevin Galpin, MD, VA’s executive director of telehealth services, told the committee. “When we talk to providers and get their satisfaction surveys back … one of the biggest challenges is the veteran not having internet or the equipment on their end.” 

VA has made some strides in closing that access gap, especially when it comes to providing equipment. As part of the CARES pandemic relief bill, $250 million was authorized for telehealth improvements. VA has used portions of that funding to provide 30,000 4G-connected iPads to veterans, 12,000 iPads to providers, along with tens of thousands of webcams, speakers and other equipment. 

As for reaching those veterans without internet access, VA first must identify them. 

“Microsoft is helping us outline the areas of the country that have a population of veterans that don’t have access to internet using our data and FCC data,” Galpin explained. In September, VA will also be launching a program where, if a provider identifies that a veteran does not have internet access, they can report that veteran to a social worker for follow up. 

“One of the tools the social workers have in their toolbelt is the Lifeline Program,” Galpin said. “If the veteran is interested, they’ll do an assessment to see if they qualify for those benefits.”

Those benefits include a $9.25 a month subsidy to help pay for internet. For veterans on tribal land, that subsidy rises to $34.25.

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