In A Remote Montana Town, The VA Hopes To Start A New Era In Veterans Health Care

Nov 11, 2019

The Department of Veterans Affairs has begun installing telehealth pods in remote locations. It's part of an ongoing VA push to shift more outpatient appointments to telehealth.

The VA has just unveiled a new way to bring heath care to veterans in some of the nation's most remote communities: tiny telehealth clinics inside VFW and American Legion posts.

That's a big deal because millions of veterans live in rural areas, many of them distant from VA clinics, but close to posts of the veterans' organizations.

Telehealth uses technology like videoconferencing to let health care professionals see patients remotely.

The first place chosen for the new program was VFW Post 6786 in Eureka, Montana. It's also the first VA telehealth site anywhere that's not part of a VA facility.

About 1,000 people live in Eureka, a former logging town just seven miles from the Canadian border on the western side of Glacier National Park.

"Most people come here specifically because it's away from all the big cities," said 75-year-old Post member and Vietnam veteran Bob Davies, who moved to Eureka from New Jersey. "But the big cities are the only places that have the hospitals and stuff."

And that's a problem for veterans like him who live in and around Eureka.

The town is 65 miles from the nearest VA medical facility - a small clinic in Kalispell, where Davies drives for telehealth appointments with a doctor who's helping him with his PTSD. The nearest full-service VA medical center is nearly 260 miles away, which can be a nine hour roundtrip.

And those aren't easy miles, especially during Northern Montana's long winters.

"Sometimes it's nothing but ice-covered road all the way," Davies said. "And in the spring and summertime it's like running a gantlet with the deer.

"Our service officer, he hit an elk one day, and it totaled his truck," Davies said.

A sign outside the Eureka, Mt. VFW post promotes the telehealth pod inside. The VA is placing pods in remote locations through a program it calls ATLAS (Accessing Telehealth through Local Area Stations).
Credit Jay Price / American Homefront

Plastic pods make doctors more accessible

But the VA and the VFW have teamed up to erase that distance. William "Doc" Schmitz, the national commander of the VFW, came all the all the way from New York to cut the ribbon on the telehealth access site at the Eureka VFW.

The facility is packed in a futuristic white and gray plastic pod the size of a utility shed, with its own pleasant lighting and ventilation systems. It takes up one corner of the room in the back of the house-sized post. 

"This is gigantic," said Schmitz, who is a retired registered nurse. "And I'll tell you a prediction: This is going to hit the civilian world. You know these walk-in clinics you go to? It might be one of these."

He said the VFW had been eager to partner with the VA on the project.

"This is going to take care of so many veterans," he said. "You don't have to be a Legion member or a VFW member to come use this pod. We are the community, we're open to the community. It's a win."

'Most people come here specifically because it's away from all the big cities,' said Eureka resident Bob Davies. 'But the big cities are the only places that have the hospitals and stuff.'
Credit Jay Price / American Homefront

The pod is part of an ongoing push by the VA to shift more outpatient appointments to telehealth. Last year for the first time, it tallied more than 1 million video visits between health care providers and veterans. Sometimes those veterans were in remote VA clinics. Other times they were at home using a tablet, phone, or computer.

But some veterans live in remote areas that don't have broadband internet service, or might not be able to afford a data plan big enough for teleconferencing. Or they might want more privacy for a consultation than they can get at home.

So the VA cut a deal with the VFW and American Legion to install telehealth equipment in posts. It's planning similar setups at libraries and Walmarts.

Representing VA Secretary Robert Wilkie at the ribbon cutting was his executive advisor, Deborah Scher.

"The Secretary made a commitment to bring health care access to every veteran," she said in an interview. "We decided to reach out to partners to extend the VA footprint, and we're building these coalitions to bridge the digital divide."

The coalitions include several cell phone providers, who have agreed not to charge for the data it takes to run the VA telehealth app veterans use at home.

The VA also has been pushing its health care providers to get up to speed on telehealth, and it has been setting up hubs of doctors in urban areas to handle telehealth visits.

Scher said a goal is to have all VA health care providers trained for telehealth. She said all are expected to complete at least one session by the end of 2020.

Wilkie said in an interview that some of the most obvious places where the VA can increase its geographic reach are in the West.

"We in the eastern United States fail to comprehend the scale of the American West, even in the year 2019," Wilkie said. "In a state like Montana, for a veteran and his family to go to a VA facility sometimes requires a round trip of 700-750 miles."

Beth Sasser, a VA doctor in Helena, Mt., conducts a telemedicine demonstration with Eureka VFW Post 6786 Commander Rick Weldon.
Credit Jay Price / American Homefront

Despite limitations, telehealth is likely to grow

Philips, the technology company that's donating the equipment, will initially install it in about 10 American Legion and VFW posts. The VA expects the pods typically to be used by patients who don't require hands-on examinations, such as those needing follow-up visits with a medical professional, nutrition and mental health counseling, medication adjustments, or ongoing diabetes care. 

Telehealth has limitations, though.

"We have to know when telemedicine is effective and when we have to physically bring people in," said Dr. Ashish Jha, a health policy professor at the Harvard School of Public Health.

"So if you see a patient who's having some chest discomfort, do you know when is it just a sprained muscle or when is it potentially early heart attack?" Jha said. "We've gotten good at figuring that out when we're seeing the patient in front of us. I worry about our ability to do that effectively over the telephone or over telemedicine."

Still, Jha predicts telemedicine will transform health care for all patients, not just veterans. He says doctors will get more accustomed to using it, while better technology - such as improved sensors - will make the remote telemedicine facilities more useful.

"It will be I think the primary way people will get health care 10, 15 years from now," Jha said.

VA officials said that the project to bring telemedicine into VFW and American Legion posts could lead to more telehealth facilities even in urban areas.

"Many people would rather not take a day off from work and have their health care session from the privacy of their own home." Scher said, "Or if they have a loved one that they are caring for who lives in another place, be able to dial into the session with the provider instead of getting on an airplane to share that doctor's visit."

"We think that this can really change lives," she said.

This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.