Bridging Gaps in Acute Care Access for Rural Veterans: The Reach and Impact of VA's Virtual Emergency and Urgent Care...

To evaluate the impact of the Veterans Health Administration's (VA) virtual acute care programs-tele-emergency care (TEC) and virtual care visits (VCV)-on short-term utilization, mortality, and costs among rural veterans.

This retrospective study used national call center data (January 2022-September 2024) linked with VA administrative and community care records. Completed TEC or VCV encounters were grouped by triage acuity: acute (recommended follow-up within 8 h; n = 61,408) and non-acute (>8 h; n = 66,319), and compared with matched controls using propensity-score methods. Primary outcomes were emergency department (ED) visits, hospital admissions, and 30-day mortality. Secondary outcomes included total, inpatient, outpatient, pharmacy, and community care costs.

Among 631,437 nurse triage calls from rural veterans, virtual care was associated with significantly lower ED visits (acute: -11.87 percentage points (pp), 95% CI -12.47 to -11.26; non-acute: -3.62 pp, 95% CI -4.02 to -3.22) and hospitalizations (acute: -0.55 pp; non-acute: -0.15 pp). Thirty-day mortality did not differ significantly in either group. Total costs were modestly higher in both groups that received virtual care (acute: +$549; non-acute: +$386), driven by outpatient spending and partially offset by lower community care costs.

Virtual acute care substantially reduced short-term emergency and hospital utilization among rural veterans across both acuity groups but was associated with higher total 30-day costs. These findings highlight the potential of embedded virtual programs to improve access for rural veterans, while underscoring the need to evaluate their long-term value and return on investment.