Increasing Access to Care for MS Veterans in Rural Areas

Paul M. Hoffman, MDDirectorVeterans Rural Health Resource Center – Eastern Region

December 5, 2014

VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 2

Office of Rural Health (ORH)

ORH Director

Secretary’s Veterans’ Rural Health

Advisory Committee(VRHAC)Veterans Rural Health

Resource Centers(VRHRCs)

VRHRC

Eastern Region

VRHRC

Central RegionStaff

AssistantBudget

Analyst

ORH Deputy

Director

VRHRC

Western Region

VRHAC

Program

Analyst

VISN Rural Consultants

(VRCs) Program

Analysts

Health Systems

Specialists

Staff

Assistant

VHA Assistant Deputy Under Secretary for Health for Policy and Planning

VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 3

Lake City VAMC

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Distribution of Veteran and non-Veteran MS patients in North Central Florida

MS Patients Self-Reported to NFNMSS

VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 5

MS Patient Population seen at NF/SGVHS

• 283 patients with MS seen at NF/SGVHS

• 120 MS patients followed at Lake City MS Clinic

• > 45% live in rural or highly rural zip codes

• Majority are progressive (primary or secondary)

• VA MS population is older, more male and disabled than non-VA population

• Access is a major issue due to disability and travel distance

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• Neurology

• Medicine

• Physical Therapy

• Occupational Therapy

• Speech, Swallowing

• Social Work

• Hospital Referrals

• Psychiatry

• Neuropsychology

• Urology

• Nutrition

‘National Multiple Sclerosis Society Affiliated Center of Comprehensive Care’ at Lake City, FL VAMC

VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 7

Care CoordinationRural Mobility Evaluation Clinic

• Evaluation and comprehensive care for rural veterans withALS, MS, SCI, PD, andneurodegenerative disorders

• Maximize independence andsafety in the home and community

• Provide VA specialty care closest to the Veterans’ home

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VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 9

Tele-presenter Demonstrating Reflexes

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Caregiver and Patient Satisfaction

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MS CVT NEUROLOGY FOLLOW-UP

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Care Extension for MS and SCI/Din Rural NF/SGVHS

• 29 CVT-Neurology F/U visits in FY13-14

• Neurology and rehabilitation televideo consultationto primary care practitioners in ruralCommunity-Based Outpatient Clinics (CBOCs)and extension clinics

• Training and consultation with HomeBased Primary Care (HBPC) teamscovering rural areas

• Physical Therapy (PT) evaluation andhome exercise program

VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 13

VETERANS RURAL HEALTH RESOURCE CENTER – EASTERN REGION (VRHRC-ER) - 14

VETERANS HEALTH ADMINISTRATION (VHA) – OFFICE OF RURAL HEALTH (ORH) - 15

• Albany, NY

• Buffalo, NY

• Baltimore, MD

• Washington, DC

• Lake City, FL

• Seattle, WA

• St. Louis, MO

• Birmingham, AL

• Denver, CO

Participating Sites MS-CVT-Neurology Follow-up

Eastern Region Coordinator—

ORH/MSCOE-EAST

Amy Kunce

Western Region Coordinator—

ORH/MSCOE-EAST Affiliate

Sean C. McCoy

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Specific Aims

Demonstrate that Neurology Follow Up Visits can be accomplished via telemedicine.

• Assess patient and provider satisfaction with telemedicine follow-up visits

• Quantify the decreased travel time for rural Veterans

• Quantify the decreased transportation expenses for patient and hospital

• Increase access to specialty care providers for rural Veterans

• Assess connectivity, dropped calls, and video clarity from hub to spoke sites.

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NEUROLOGY CVT - FY 2013 & 2014

FY 2013

• 59 Unique Veterans Served ALL Sites

• 46% Rural Veterans

• Average of 3 hours of roundtrip travel/Veteran

• >95% Veteran Satisfaction

FY 2014

• 36 MS Veterans Served NF/SGVHS

• 16 Rural MS Veterans

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Rural Veteran TeleRehabilitation Initiative (RVTRI)

• The RVTRI:

– Completed 205 initial evaluations

– Enrolled 127 veterans for ongoing care

– Generated a workload of 2134 encounters

– Reached Veterans in 30% (40/137) of our rural zip codes(Veterans served lived an average of 93 miles from the medical center)

• VHA Systems Redesign Champion Award –Outpatient Category

Clinical Video Telehealth (CVT)

Home-based Physical TherapyExercise Intervention

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FY 2013 NF/SGVHS

• 37 Unique Veterans

• 210 Total Rehabilitation Encounters

• Saving over 40,000 Travel Miles and $18,500 in reimbursement

FY 2014 NF/SGVHS

• 16 Unique Veterans

• 59 CVT Rehab Encounters

• Saving over 10,696 Travel Miles and $4947 in reimbursement

CVT-REHAB – Hub to Home NF/SGVHS

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CVT-REHAB – Hub to Home