Rural providers praise EPS but warn onboarding, security and document exchange must improve
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Summary
Nebraska and rural health witnesses told the subcommittee EPS can improve access for rural veterans but recommended funding help for EHR interfaces, alignment with EHR vendors, quality metrics and expedited secure referral exchange (FedRAMP High) so referral packages can be delivered electronically to community providers.
Representatives of Nebraska's rural health community told the House Veterans Affairs subcommittee that the External Provider Scheduling program shows early promise in rural states but that practical impediments remain for broad adoption.
"Nebraska's success shows that national innovation, when paired with local engagement, along with trusted partners, can produce some meaningful results for our veterans," Jed Hansen, executive director of the Nebraska Rural Health Association, told the subcommittee.
Hansen said Nebraska has 50 independent provider groups live on EPS and 35 critical access hospitals engaged, with eight in active onboarding. He urged Congress and the VA to help offset IT interface fees for smaller providers and to align EPS integration with large EHR vendors so small rural providers can connect without prohibitive cost.
"Potentially partnering or working with some of our EHR vendors so that when they do have an update that's rolling out, so that that interface could be more, in line or more friendly to connecting with WellHive would be significant," Hansen said. "Providing some sort of an appropriation to our critical access hospital partners so that they don't have to — they're not burdened with some of that extra cost" could accelerate adoption.
Committee members also raised the security and referral-document issue. Several representatives asked whether EPS can transmit the full referral package and authorization electronically to the community provider at booking rather than relying on fax or secure email. Chris Farajii said WellHive had completed FedRAMP High activities and submitted its security assessment to the VA and that once the security review and system integrations are complete, the platform will include the referral package with the scheduled appointment.
"We just completed our FedRAMP high authorization. We submitted our security assessment to VA. They're reviewing, and that should be completed by fall of this year," Farajii told the subcommittee. "At the point where the scheduled appointment is booked, we will also be including that referral package with the appointment."
Members emphasized the importance of collecting and reporting quality and timeliness metrics from community providers so veterans can make informed choices between VA direct care and community care. Dr. Arfons said VA is building a more robust quality program, that network adequacy is measured through third-party administrators, and that VA runs the exclusions list daily for provider eligibility checks.
Hansen offered additional implementation recommendations: time-limited enhanced payments to incentivize academic and tertiary providers, leveraging state rural health associations as local liaisons, and continued engagement with national partners such as the National Rural Health Association.
No votes or formal policy changes were taken at the hearing; witnesses and committee members agreed to continue oversight and further technical coordination to address security, provider onboarding costs, and collection of quality metrics.
