Consider a veteran who comes home from his last tour to his family in the mountains of West Virginia. He finds solace in the slowness and solitude of the land he has worked so hard to call his own. He spends time with his family and starts the transition to the slower pace of life, but his health is never the same. He served his country proudly. Now he needs a specialist to live comfortably, and the nearest one is three hours away.
That is the reality for millions of veterans and rural Americans across the country, but it doesn’t have to be.
A proven solution
I’ve seen both sides of this story. When I joined the Department of Veterans Affairs as undersecretary for health in 2015, the agency was still recovering from a national wait-time crisis, and veterans who needed outpatient specialty care often waited longest. For decades, a veteran who needed a specialist’s opinion first needed a face-to-face specialist visit, even when the question could have been answered from his chart. For a veteran living hours from the nearest VA medical center, that could mean a full day on the road, or no care at all.
Starting in 2011, the VA began using e-consults, which let a primary care clinician send a patient’s question and records to a specialist and get guidance back without a separate appointment. As undersecretary and later as secretary, I watched that approach expand across the system.
From 2012 to 2018, VA clinicians completed more than 3.1 million e-consults, and use grew by more than 300%. By 2018, about a third of veterans receiving e-consults lived in rural areas. Nearly 8 in 10 e-consults did not lead to an in-person visit with that specialty within a year. Researchers estimated that each avoided trip spared a veteran about 84 miles of driving: 170 million miles in all, and more than $46 million in VA travel reimbursement.
The data prove it works. On a human level, it means less waiting and traveling and more time with families and loved ones.
Why this matters now
Recently, 97% of VA facilities reported severe shortages of physicians. With more than 4 million veterans living in rural America, these shortages hit them the hardest. Their civilian neighbors face the same challenge.
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Through the federal Rural Health Transformation Program, every state is receiving a share of $50 billion over five years, and telehealth and digital tools that speed access to care are an allowed use. Standing up e-consult is one proven way to put those dollars to work.
We have an opportunity to embrace a readily available solution that can better support rural veterans and all rural Americans. Let’s use it.
David J. Shulkin is a physician and health policy leader. He served as the ninth U.S. Secretary of Veterans Affairs (2017–2018) and as VA undersecretary for health (2015-2017). He is an adviser to Safety Net Connect, a health technology company that provides e-consult services.
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[ H/T Washington Examiner ]
