Veterans Health Administration (VA) funding of community care (i.e., non-VA clinicians contracted by VA) aims to improve access for veterans; however, community care expenditures rose five-fold from $7.9 billion to $40 billion between fiscal years 2014 and 2024. VA telemedicine offers a convenient, high-quality alternative to some types of community care. We examined patient preferences for VA video visit versus in-person community care.
Methods
This cross-sectional study combined primary data from a national survey of patients who received both VA and community in-person care plus VA video visits (April to June 2023) with VA administrative data. We assessed the proportion of patients who preferred VA video visits versus community care in-person, and reasons for preference. We used multivariate logistic regression to identify predictors of preference.
Results
Fully 44% of patients had either no preference (24%) or preferred a VA video visit (20%) over a community in-person visit in future. Top reasons for preferring a VA video visit were: convenience, avoiding infection, shorter wait times, and VA care quality, further stratified across six service areas. Two significant predictors of preference for VA video care were: (1) having a prior positive VA video visit experience (odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.55, 3.14) and (2) having a prior negative community care referral and authorization experience (OR = 2.69, 95% CI = 1.10, 6.59).
Discussion
Continued support for VA providers and patients in their digital training and device access for a positive telemedicine experience could encourage many patients among the millions referred to community care to stay with VA care.
MattocksKMKroll-DesrosiersAKinneyR, et al.Understanding VA’s use of and relationships with community care providers under the MISSION Act. Med Care2021; 59: S252–S258.
7.
ApaydinEARoseDEMcCleanMR, et al.Association between care coordination tasks with non-VA community care and VA PCP burnout: an analysis of a national, cross-sectional survey. BMC Health Serv Res2021; 21: 09.
8.
O'HareAMButlerCRLaundryRJ, et al.Implications of cross-system use among US veterans with advanced kidney disease in the era of the MISSION Act: a qualitative study of health care records. JAMA Intern Med2022; 182: 710–719.
9.
GovierDJHickokAEdwardsST, et al.Early impact of VA MISSION Act implementation on primary care appointment wait time. J Gen Intern Med2023; 38: 889–897.
10.
ZhengDXCwalinaTBFriedlSL, et al.Outpatient dermatology appointment wait times for United States military veterans, 2014–2021. Arch Dermatol Res2025; 317: 73.
11.
BenzerJKGurewichDSingerSJ, et al.A mixed methods study of the association of non-veterans affairs care with veterans’ and clinicians’ experiences of care coordination. Med Care2020; 58: 696–702.
12.
RosenAKVannemanMEO'BrienWJ, et al.Comparing cataract surgery complication rates in veterans receiving VA and community care. Health Serv Res2020; 55: 690–700.
13.
VannemanMEWagnerTHShwartzM, et al.Veterans’ experiences with outpatient care: comparing the veterans affairs system with community-based care: study compares veterans’ experiences in VA-delivered and community-based outpatient care. Health Aff2020; 39: 1368–1376.
14.
LeDEAroraBLKellyFR, et al.The quality of veterans healthcare administration cardiovascular care. JACC Adv2025; 4: 101533.
15.
MaYPhelanJOravEJ, et al.Veterans may be seeing lower-quality clinicians in the VHA community care network. Health Aff (Millwood)2025; 44: 117–125.
16.
VannemanMERobertsETLiY, et al.Experiences with VA-purchased community care for US veterans with mental health conditions. JAMA Netw Open2025; 8: e2511548.
17.
YoonJChowAJiangH, et al.Comparing quality, costs, and outcomes of VA and community primary care for patients with diabetes. J Gen Intern Med2025; 40: 647–653.
18.
RosenAKBeilstein-WedelEShwartzM, et al.Racial and ethnic and rural variations in access to primary care for veterans following the MISSION Act. JAMA Health Forum2024; 5: e241568.
19.
KrishnamurthySLiYSileanuF, et al.Racial and ethnic differences in health care experiences for veterans receiving VA community care from 2016 to 2021. J Gen Intern Med2024; 39: 2249–2260.
20.
RasmussenPFarmerCM. The promise and challenges of VA community care: veterans’ issues in focus. Rand Health Q2023; 10: 9.
21.
RoseLTranDWuS, et al.Payer shifting after expansions in access to private care among veterans. Health Serv Res2023; 58: 1189–1197.
22.
BurkeLGMaYPhelanJ, et al.Cost shifting for emergency care of veterans with Medicare after MISSION Act implementation. JAMA Health Forum2024; 5: e244312.
23.
KizerKWIbrahimS. Medicare to veterans affairs cost shifting—a challenging conundrum. JAMA Health Forum2024; 5: e244319.
24.
MehtsunWTMaYLatskoE, et al.Payment source shift for surgical care among veterans enrolled in Medicare advantage plans. JAMA Health Forum2025; 6: e250827.
HoganTPShermanSEDardashtiN, et al.Realizing virtual care in VA: supporting the healthcare system's journey towards enhanced access, engagement, and outcomes. J Gen Intern Med2024; 39: 1–4.
27.
TisdaleRLBurnettKRogersM, et al.An approach to evaluating the impact of virtual specialty care: the Veterans Health Administration's clinical resource hub as case study. JAMIA Open2025; 8: ooaf038.
28.
WrayCMMyersUSlightamC, et al.Research priorities to expand virtual care access for patients in the veterans affairs health care system. J Gen Intern Med2024; 39: 14–20.
29.
DavilaHRosenAKBeilstein-WedelE, et al.Rural veterans’ experiences with outpatient care in the veterans health administration versus community care. Med Care2021; 59: S286–S291.
30.
GarvinLAPugatchMGurewichD, et al.Interorganizational care coordination of rural veterans by veterans affairs and community care programs: a systematic review. Med Care2021; 59: S259–S269.
31.
GurewichDShwartzMBeilstein-WedelE, et al.Did access to care improve since passage of the veterans choice act?: Differences between rural and urban veterans. Med Care2021; 59: S270–S278.
32.
MillerCGurewichDGarvinL, et al.Veterans affairs and rural community providers’ perspectives on interorganizational care coordination: a qualitative analysis. J Rural Health2021; 37: 417–425.
GarvinLAHuJSlightamC, et al.Use of video telehealth tablets to increase access for veterans experiencing homelessness. J Gen Intern Med2021; 36: 2274–2282.
35.
MattocksKMWalkerLKroll-DesrosiersA, et al.Assessing rural veterans’ experiences with a tele-nephrology program in the Veterans Health Administration (VHA). Am J Nephrol2025. DOI: 10.1159/000546917.
36.
FergusonJMJacobsJYefimovaM, et al.Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc2021; 28: 453–462.
37.
HeyworthLKirshSZulmanDM, et al.Expanding access through virtual care: the VA’s early experience with COVID-19. NEJM Catalyst Innovations in Care Delivery2020; 1: 1.
38.
SlightamCGregoryAJHuJ, et al.Patient perceptions of video visits using veterans affairs telehealth tablets: survey study. J Med Internet Res2020; 22: e15682.
39.
ZulmanDMWongEPSlightamC, et al.Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open2019; 2: 323–329.
ZulmanDMVergheseA. Virtual care, telemedicine visits, and real connection in the era of COVID-19: Unforeseen opportunity in the face of adversity. Jama2021; 325: 437–438.
42.
GujralKVan CampenJJacobsJ, et al.Mental health service use, suicide behavior, and emergency department visits among rural US veterans who received video-enabled tablets during the COVID-19 pandemic. JAMA Netw Open2022; 5: e226250–e226250.
43.
DhananiZFergusonJMVan CampenJ, et al.Overcoming access barriers for veterans: cohort study of the distribution and use of veterans affairs’ video-enabled tablets before and during the COVID-19 pandemic. J Med Internet Res2023; 25: e42563. Original Paper 26.1.2023.
44.
FergusonJMWrayCMJacobsJ, et al.Variation in initial and continued use of primary, mental health, and specialty video care among veterans. Health Serv Res2023; 58: 402–414.
45.
WrayCMFergusonJMGreeneL, et al.Overcoming obstacles: barriers to virtual care use among video-enabled tablet recipients in the veterans health administration. J Gen Intern Med2024; 39: 549–556.
46.
El-ShahawyONicholsonAIllenbergerN, et al.Comparing veterans preferences and barriers for video visit utilization versus in-person visits: a survey of two VA centers. J Gen Intern Med2024; 39: 106–108.
47.
LumJSadejIPizerSD, et al.Telehealth access and substitution in the VHA. J Gen Intern Med2024; 39: 44–52.
48.
von ElmEAltmanDGEggerM, et al.The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol2008; 61: 344–349.
WheelockAMiraldoMThomsonA, et al.Evaluating the importance of policy amenable factors in explaining influenza vaccination: a cross-sectional multinational study. BMJ Open2017; 7: e014668.
51.
JasujaGKMeterkoMBradshawLD, et al.Attitudes and intentions of US veterans regarding COVID-19 vaccination. JAMA Netw Open2021; 4: e2132548–e2132548.
52.
NelsonLAPenningsJSSommerEC, et al.A 3-item measure of digital health care literacy: development and validation study. JMIR Form Res2022; 6: e36043. Original Paper 29.4.2022.
53.
ChristmannPGummerTHäringA, et al.Concurrent, web-first, or web-only? How different mode sequences perform in recruiting participants for a self-administered mixed-mode panel study. J Surv Stat Methodol2024; 12: 532–557.
54.
DillmanD. The promise and challenge of pushing respondents to the web in mixed-mode surveys. Surv Methodol2017; 43: 3–30.
55.
VimalanandaVGWormwoodJBSitterKE, et al.Adaptations for remote research work: a modified web-push strategy compared to a mail-only strategy for administering a survey of healthcare experiences. BMC Med Res Methodol2023; 23: 44.
56.
FergusonJMWrayCMVan CampenJ, et al.A new equilibrium for telemedicine: prevalence of in-person, video-based, and telephone-based care in the veterans health administration, 2019-2023. Ann Intern Med2024; 177: 262–264.
57.
ParastLMMathewsMElliottM. Effects of push-to-web mixed mode approaches on survey response rates: evidence from a randomized experiment in emergency departments. Surv Pract2019; 12: 1–26.
58.
AldrichJNelsonF. Linear probability, logit, and probit models. Thousand Oaks, CA: Sage, 1984.
59.
WrightRE.. Logistic regression. In: GrimmLGYarnoldPR (eds) Reading and understanding multivariate statistics. Washington, D.C.: American Psychological Association, 1995, pp.217–244.
60.
TabachnickBGFidellLS. Using multivariate statistics. 6th ed. Boston, MA: Pearson, 2013.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
