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VHA Office of Rural Health

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Enterprise-Wide Initiative (EWI) - Specialty Care

National TeleHospital Medicine Program

Background

The National TeleHospital Medicine (Tele-HM) Enterprise-Wide Initiative (EWI) was created in 2024 to address serious shortages of inpatient providers across the Veterans Health Administration (VHA), especially in rural areas. In 2024, 86% of VHA facilities reported critical inpatient provider shortages, with rural and low-complexity medical centers being affected the most.

Traditional ways of filling staffing gaps, such as using temporary contract providers (locum tenens), are often very expensive and can lead to lower quality of care. At the same time, Advanced Practice Providers (APPs) are taking on more inpatient medicine roles, but many do not receive focused hospital medicine training. Without close collaboration with a physician, this can lead to inefficiencies and a higher risk of adverse events.

Tele-HM began in 2019 as a project of the VHA Office of Rural Health (ORH) Veterans Rural Health Resource Center–Iowa City. It has grown from a pilot into a national EWI that provides inpatient care through telehealth, 24 hours a day, 7 days a week, 365 days a year.

The Tele-HM program has increased efficiency of care, improved patient outcomes, reduced reliance on contract labor, and supported training for APPs. In Fiscal Year (FY) 2024, Tele-HM expanded to three additional facilities and started night coverage, achieving full 24/7/365 services. Since October 2024, services have expanded to cover nine active hospitals.

Today, Tele-HM supports multiple rural VA facilities with staffing shortages. The program helps these facilities keep inpatient beds open, uses VHA hospitalists more efficiently, and ensures that Veterans receive high-quality inpatient care close to home.

Goals and Objectives

The mission of the Tele-HM program is to provide the highest-quality inpatient care to Veterans, no matter where they are admitted. By using telehealth technologies, the program aims to:

  • Improve access to inpatient medicine expertise and quality of care: Make sure Veterans receive consistent, high-quality inpatient medicine expertise closer to home, regardless of which VA facility they are admitted to.
  • Optimize staffing and resource use: Reduce staffing costs and optimize hospitalist deployment by allowing telehospitalists to cover multiple sites at the same time, while onsite providers focus on the sickest patients.
  • Strengthen the workforce: Train local APPs and residents in hospital medicine to build a sustainable pipeline of future inpatient providers for rural VA facilities.

Methodology

Tele-HM uses flexible schedules and telework to build a network of experienced, board certified VHA hospitalists. These telehospitalists can cover several rural facilities at once using telehealth. The program uses three main care models.

  • Team-based care model: The telehospitalist works together with an APP or trainee at a rural site, providing direct supervision and customized training for local providers.
  • Consultative care model: Telehospitalists are available for real-time consultations with experienced APPs or non-hospitalist physicians, such as surgeons or mental health providers.
  • Cross-coverage support model: The telehospitalist provides after-hours, weekend, and holiday coverage for inpatients, facilitates new admissions, and supervises onsite trainees. This model is growing quickly as more facilities request coverage.

The Tele-HM program follows a structured, multi phase implementation strategy:

    1. Pre implementation (about 3 months): Bi weekly planning calls are held to set up protocols, train local staff, and complete an onboarding checklist. Program leaders work with local stakeholders to identify needs, choose care models, and define the scope of services.
    2. Implementation: Telehospitalists use synchronous video and telephone consultations to perform real-time patient evaluations, place orders, document care, and escalate concerns to onsite providers or higher levels of care when needed.
    3. Evaluation and continuous improvement: The program regularly monitors consultation volumes, care quality, provider and facility adoption, and program reach. Veteran experience is measured through phone surveys, and provider and care-team satisfaction surveys are conducted before implementation and again at 6, 12, and 24 months afterward.

Impact on Rural Veteran Health

Tele-HM has steadily expanded to meet the needs of rural Veterans. The program has been implemented at ten rural VA medical centers, completing more than 7,500 patient encounters and caring for over 2,500 Veterans, most of whom live in rural communities. Services can be ongoing or activated on demand to cover staffing gaps, helping sites keep their inpatient beds open.

Tele-HM met its recent expansion goals by activating three additional rural VHA facilities—Clarksburg, West Virginia; Beckley, West Virginia; and White River Junction, Vermont—and by starting night coverage in September 2024 to provide continuous service every day.

In its first year as an ORH Enterprise-Wide Initiative, the program completed 1,579 encounters and covered up to 160 beds per day, with an average of 78 beds covered each day. The Tele-HM team supervised three nurse practitioners and provided oversight for night residents, helping to train the next generation of rural hospital providers.

Decreasing costs and supporting rural facilities:

  • One telehospitalist can cover multiple units and facilities at the same time, reducing the need for multiple onsite providers and lowering costs at the facility, regional (VISN), and national levels.
  • This shared-resource model allows onsite providers to concentrate on Veterans who need the highest level of care, reduces the need for internal and external transfers, and lowers overall cost of care.
  • Because Tele-HM operates across many facilities, it helps standardize processes, policies, and evidence-based practices.
  • Facilities using the Tele-HM cross-coverage model reported an average reduction of 1.5 full-time equivalent (FTE) onsite night positions, with estimated cost savings of $400,000–$600,000 per year per site.

Improved outcomes and care-team experience:

  • Comparative analyses show that Veterans cared for under the Tele-HM care-team model had similar or better outcomes than those treated by in-person hospitalists.
  • Acute care mortality (1.2% vs. 1.9%) and 30 day mortality (6.0% vs. 6.2%) were lower in the Tele-HM group, even though these Veterans tended to be older and had more medical conditions.
  • Care-teams report high satisfaction with the program. A survey of 20 providers across three sites showed strong support for Tele-HM. Open-ended comments described telehospitalists as providing excellent care, being easy to work with, and being helpful and responsive.

Increased Veteran satisfaction:

  • In a phone survey of 33 randomly selected Veterans, 96% said they were very satisfied with their Tele-HM care.
  • All Veterans surveyed (100%) said their Tele-HM physician listened to them and explained things clearly.
  • Most Veterans (88%) rated their hospital stay as a 9 out of 10 experience.

Key Takeaways

  • The National Tele-HM Program shows the federal government’s commitment to efficient, high quality health care delivery. Tele-HM is a cost effective, safe, and efficient way to deliver inpatient care while making the best use of the VA workforce.
  • The program’s impact goes beyond cost savings. Tele-HM improves patient outcomes, supports consistent use of best practices across facilities, and helps develop and sustain the inpatient care workforce in rural areas.
  • The success of the National Tele-HM Program demonstrates its potential for further expansion to additional VA hospitals, helping advance goals related to workforce optimization, high-quality care for Veterans, and government efficiency.

National TeleHM Overview PDFDownload the Printable PDF for Healthcare Providers and Researchers.

References

  • OIG Determination of Veterans Health Administration’s Severe Occupational Staffing Shortages Fiscal Year 2024. U.S. Department of Veterans Affairs Office of Inspector General.
  • Gutierrez J., Moeckli J., McAdams N., Kaboli P. J. Perceptions of telehospitalist services to address staffing needs in rural and low-complexity hospitals in the Veterans Health Administration. Journal of Rural Health. 2019.
  • Blumenthal D. M., Olenski A. R., Tsugawa Y., Jena A. B. Association between treatment by locum tenens internal medicine physicians and 30 day mortality among hospitalized Medicare beneficiaries. JAMA. 2017;318(21):2119–2129.
  • Chan D. C. J., Chen Y. The productivity of professions: Evidence from the emergency department. National Bureau of Economic Research; 2022;30608.
  • Gutierrez J., Moeckli J., Holcombe A., O’Shea A. M., Bailey G., Rewerts K., Hagiwara M., Sullivan S., Simon M., Kaboli P. Implementing a telehospitalist program between Veterans Health Administration hospitals: Outcomes, acceptance, and barriers to implementation. Journal of Hospital Medicine. 2021;16(3):156–163.

Contact

  • Program Contact: Jeydith Gutierrez, MD, MPH, Program Manager, Iowa City VA Health Care System, Iowa City, IA. Jeydith.Gutierrez@va.gov
  • Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00585.
  • Suggested Citation: Jindal, N., Lestina, M., Vinzant, J., Moffett, T., Wray, C., & Gutierrez, J. (2025). National TeleHospital Medicine (Tele-HM) Program. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

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