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VA Seeks to Eliminate Copay for In-Home Video Health Care

Published by CQ Healthbeat
Jane Norman
April 6, 2012

As Medicare is experimenting with plans for more extensive in-home health care it could look to the Veterans Affairs Department, which has had a similar program in place for three decades, one the VA is proposing to make even easier to use.

The VA wants to do away with copayments for video telehealth care that veterans get in their homes, a kind of video "house call." A proposed rule posted on the Federal Register says that the agency wants to remove any barriers that might be present for veterans who are ill, frail and have problems traveling to medical centers or clinics.

"In turn, VA hopes to make the home a preferred place of care, whenever medically appropriate and possible," the agency says. The no-copayment rule would be effective May 7.

A number of veterans live in rural areas or at a distance from VA health care at hospitals or medical centers, and they get health care in their homes through telehealth services. Through telehealth, health care providers can assess the state of veterans' health in areas such as wound management, psychiatric care, exercise plans and medication management, according to the VA statement.

The VA program that provides the care is called the Home Based Primary Care program. It is aimed at patients with long-term, chronic diseases and conditions, and who are at risk for hospitalization. Established in 1972, the program is unique among government health care programs and different from the limited home care currently available in Medicare and Medicaid, according to agency documents. The VA program includes palliative care, rehabilitation, disease management and coordination of care.

An analysis of costs found that enrollment in the VA home program resulted in a 59 percent reduction in hospital bed stays, an 89 percent reduction in days spent in nursing homes and a 21 percent reduction in 30-day hospital readmission rates, according to a paper presented at a National Health Policy Forum session inJuly. The nonpartisan forum is headquartered at George Washington University.

Other agencies are following the VA's lead when it comes to encouraging home care. A provision in the health care law requires the Centers for Medicare and Medicaid Services to conduct an "independence at home" demonstration project. It was launched this year for Medicare enrollees andcould follow in the path of the VA program.

The amount of the VA copayment now required depends on services furnished and how much time and effort they entail, the VA statement says. Generally outpatient copays at the VA start at $15.

The agency has decided that VA "in-home video telehealth care should be exempt from copayments because it is not used to provide complex care and its use significantly reduces impact on VA resources compared to an in-person, outpatient visit," the statement says.

The comment period for the proposed rule ended Friday and the Partnership for Quality Home Healthcare, a group of home health care providers, praised the VA for doing away with thecopay. "We applaud the VA for recognizing that copayments can shift patients to more costly settings and increase health care costs," said Billy Tauzin, chairman of the group.

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