Enterprise-Wide Initiative (EWI) - Specialty Care
High-Risk Eye and Limb Preservation Program (HELPP)
Background
The High-Risk Eye and Limb Preservation Program (HELPP) helps fill a gap in podiatry services at many rural and highly rural VA clinics. The program offers high-risk Veterans preventive Basic Foot Care (BFC) and related services in areas where podiatry is not available. These clinics use telehealth and in-person care to help prevent amputations and vision loss.
HELPP uses Intermediate Care Technicians (ICTs) who are trained by a podiatrist and certified through VA courses to perform basic foot exams, basic foot care (such as nail and callus trimming), and basic wound care. Veterans can also receive eye screenings and measurements for diabetic and therapeutic footwear as part of this comprehensive care.
HELPP began as a pilot program at the Atlanta VA Health Care System in 2020 to remotely evaluate Veterans at higher risk for amputation during the COVID‑19 pandemic. Positive results led to making the program permanent at that site. In 2025, HELPP began national expansion through Office of Rural Health (ORH) Enterprise-Wide Initiative (EWI) funding. The program works with the Specialty Care Program Office, National Podiatry Program Office, and the QUERI Center for Evaluation and Implementation Resources to collect data and evaluate outcomes.
Goals and Objectives
The main goal of HELPP is to improve access to care and health outcomes for Veterans at increased risk of amputation and blindness in rural and highly rural areas, while improving the overall care experience for rural Veterans.
Key objectives include:
- Approve and post podiatrist and ICT positions by the end of the first quarter of the first funding year.
- Select and onboard candidates for these positions by the end of the second quarter.
- Complete all required ICT clinical training by mid- to late third quarter.
- Open and begin operating HELPP clinics by the end of the fourth quarter.
- Provide care for about 500 Veterans each year at each HELPP site.
Methodology
Once a site is selected through the request for applications (RFA) process, HELPP leadership begins monthly meetings with that site’s stakeholders. After each meeting, HELPP shares written summaries and action items to keep planning on track.
Early steps include working with local leaders to approve ICT and podiatrist positions, recruiting and hiring for those roles, and setting up clinic space and equipment. Sites must secure basic clinic equipment such as a treatment chair, storage cabinets, government-furnished equipment, and telehealth tools.
After hiring, ICTs travel to the Atlanta site (station 508) for hands-on clinical training with HELPP leaders. Training follows VHA directives and leads to certification through a national course. ICTs build skills in foot care, wound care, communication, documentation, and medication-related tasks allowed by policy. If a site plans to offer diabetic shoe measurement or eye screening, ICTs receive additional training from prosthetics and ophthalmology teams. ICTs are not released to work at their home site until all competencies are met.
While ICTs are in training, adopting sites work on clinic operations. This includes building clinic grids, creating the HELPP consult template, reviewing incoming consults, and scheduling Veterans. Existing VA podiatry clinics can also send appropriate basic foot care patients to HELPP through return-to-clinic orders when it makes geographic sense. To support consistent documentation and data collection, sites use a standard HELPP note template that generates key data elements.
Successful HELPP clinics depend on close communication between local sites and the HELPP leadership team. Sites are expected to follow the HELPP Standard Operating Procedure, keep equipment and supplies at needed levels, and work with HELPP leaders to solve problems and improve processes. Sites provide regular updates to ORH and stakeholders, and podiatrists’ clinical performance is monitored through ongoing professional performance evaluations (OPPEs).
Impact on Rural Veteran Health
Although interest in HELPP has been strong, HELPP clinics did not open before October 1, 2025. Hiring delays, adoption challenges, and other expansion barriers in fiscal year 2025 slowed implementation more than expected. As a result, there were no rural Veterans served and no clinical outcomes to report for that year.
Several sites did make progress toward launch, including approval and hiring for podiatrist and ICT positions, but these staff were still in training or not yet active in HELPP clinics by the end of FY2025.
Key Takeaways
Even without measurable clinical outcomes yet, HELPP leaders have identified important areas for improvement to support future success:
- Provider productivity: Challenges enrolling Veterans from community care and bringing them back into VA have affected podiatrist productivity. HELPP leaders are working with the National Podiatry Office to create a Podiatry Telehealth Hub to increase provider availability, share coverage across sites, and reduce clinic cancellations.
- Clinical access: Community Care rules, including changes under the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, have made it harder to enroll Veterans into HELPP. HELPP leaders are exploring ways to adjust consult templates and scheduling so HELPP is better reflected in tools that guide care decisions and access.
- Data retrieval: To improve data quality and reporting, HELPP created a national HELPP note template with built-in health factors. This helps sites capture key information in a consistent way and supports reliable reporting to ORH and other partners.
These process improvements are intended to strengthen future implementation so that HELPP can fully deliver on its goal of preventing amputations and vision loss for rural Veterans at high risk.
- VHA Directive 1122, Podiatric Medical and Surgical Services.
- VHA Directive 1194, Use of Unlicensed Assistive Personnel in Administering Medication.
- VHA Directive 1410, Prevention of Amputation in Veterans Everywhere (PAVE) Program.
Contact
- Program Contacts: Sherrill Murad, DPM, National Program Manager, ORH EWI HELPP, Joseph Maxwell Cleland Atlanta VA Health Care System, Atlanta, GA. Sherrill.Murad@va.gov; Ashley Willis, DPM, National Program Lead, ORH EWI HELPP, Joseph Maxwell Cleland Atlanta VAHCS – Pike CBOC, Atlanta, GA. Ashley.Willis@va.gov; Nichol Salvo, DPM, National Podiatric Medical Director, Specialty Care Program Office, VACO; ORH EWI Subject Matter Expert, Joseph Maxwell Cleland Atlanta VAHCS, Atlanta, GA. Nichol.Salvo2@va.gov
- Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PROG-0000116.
- Suggested Citation: Salvo, N.; Murad, S.; and Willis, A. (2026). High-Risk Eye and Limb Preservation Program (HELPP). Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.
Rural Health - Navigation
- Office of Rural Health Home page:
https://www.ruralhealth.va.gov/index.asp - Enterprise-Wide Initiatives (EWI) page:
https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp - Veterans Rural Health Resource Centers (VRHRC) page:
https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp
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