What started as a pilot serving a rural Department of Veterans Affairs (VA) hospital in Wisconsin has expanded to 15 more sites across 11 states and covering up to 400 beds at any given day. The Veterans Health Administration (VHA) Telehospitalist Program (Tele-HM) has grown into a national enterprise-wide initiative since the VHA Office of Rural Health (ORH) Veterans Rural Health Resource Center in Iowa City funded the initial pilot project in 2019. ORH recently renewed the program’s funding for another three years, with an annual budget of $3.9 million in fiscal year 2027 with funding expected to continue through fiscal year 2029.
Clinical Professor in Hospital Medicine, Jeydith Gutierrez, MD, MPH, has directed the service Tele-HM project since its start. Although telemedicine became more common during the COVID-19 pandemic, Gutierrez said the program predates the pandemic and was created in response to an ongoing shortage of hospitalists in rural and underserved areas. “With the telehospitalist program, we can reach patients in facilities that are geographically distant and support inpatient care,” Gutierrez said.
Telehospitalists use video and audio technology to evaluate patients remotely, with access to medical records, vital signs, laboratory results, and imaging. A nurse or advanced practice provider at the patient’s bedside can help conduct the physical exam, and additional equipment allows the physician to listen to a patient’s heart and lungs remotely.
The program’s first site was a 10-bed rural VA hospital in Wisconsin. Most of the hospitals it now serves are in rural or underserved areas. This service benefits all patients in a hospital system—whether they use the telehospitalist service or see a hospital’s on-site provider(s).
“These facilities often lack the patient volume to justify a 24-hour in-person physician coverage in inpatient areas.” Gutierrez said. “What we are able to provide is 24/7 access to hospital medicine expertise and allow the on-site providers to really focus on the patients that need the bedside care or those that are in the emergency room.”
Before the Tele-HM program, providers at rural sites could be on call around the clock or remain at the hospital for stretches as long as 72 hours. Gutierrez said telehospitalist coverage has helped hospitals recruit and retain clinicians while reducing the burden of those already working there. The program has also brought about savings for the VA by reducing the need for overnight and weekend on-site staffing and helping facilities continue caring for veterans within the healthcare system.
At some sites, the program’s reach now extends beyond the hospital. Telehospitalists work with community living centers —VA’s nursing home facilities—to care for patients after discharge, and those receiving hospice care. The program also provides medical co-management for veterans in residential treatment programs.
“It allows us to provide medical care and address their chronic medical conditions while they are also going through the recovery process,” Gutierrez said. “It has been very fulfilling to see the impact that we can have for caring for the veterans in this environment. It has allowed us to expand the practice and the scope of hospital medicine.”
Managing 15 sites has required the service’s team to rethink how clinicians communicate. A recently developed triage tool funnels requests from participating hospitals into one system, where telehospitalists can prioritize patients based on the urgency of their needs. Other tools help providers manage handoffs and pending tasks.
Gutierrez expects this type of technology to continue developing over the next three years. Artificial intelligence could eventually help physicians monitor more patients and identify early signs of clinical deterioration, while telehealth equipment itself has become easier and less expensive to implement.
The program has also created a network of physicians across the VHA. Many telehospitalists have previous VA experience and maintain an in-person practice at their home facility while working part time with the national program. Gutierrez said that arrangement brings expertise from multiple VA medical centers into one pool and gives physicians a way to share best practices across sites.
As the program has expanded, Gutierrez credits its staff with finding ways to standardize care while accounting for the needs of each hospital. She specifically highlights Neha Jindal, MD, the program’s deputy director; Melissa Lestina, RN, nurse coordinator; and Judy Vinzant, program specialist.
“I think having a great team has really been the key to making this successful,” she said. “There has to be a balance between scalability and a standardization that allows our processes to be similar between sites and also tailoring to local resources.”
Peter Kaboli, MD, ORH Executive Director, has seen the impact of this program on rural hospitals. “If the National Telehospitalist program didn’t exist, several services at these rural hospitals may have had to close permanently or temporarily. Providing these services not only kept the units open but saved the VA other costs of care and ensured access to high-quality hospital medicine care for rural Veterans.”
Now with funding secured through 2029, the program is positioned to continue expanding acess to hospital medicine expertise for veterans in rural and underserved communities across the country.
Learn more about the ORH Tele-Hospital Medicine Enterprise-Wide Initiative on the ORH website, www.ruralhealth.va.gov.