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

PURPOSE: 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. METHODS: 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. FINDINGS: 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. CONCLUSIONS: 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.