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The SHOW UP Act Threatens VA Telehealth

By Russell Lemle + Katherine McGuire

Appeared in Federal Practitioner March 7, 2023

Last month, the U.S. House of Representatives hurriedly passed the Stopping Home Office Work’s Unproductive Problems (SHOW UP) Act (H.R. 139), a bill that calls into question the contributions of federal employees allowed to work from home and resets telework policies to those in place in 2019. Its author, House Oversight Committee Chairman James Comer, of Kentucky, claimed this change was necessary because the expansion of federal telework during the COVID-19 pandemic “has crippled the ability of agencies to get their jobs done and created backlogs.” His targets included the Department of Veterans Affairs (VA), where, he charged, “veterans have been unable…to obtain care they have earned.” He added, "it’s hard to argue that teleworking has helped the VA.”

While oversight of government programs is an authority of Congress, the SHOW UP Act is based on unsubstantiated assumptions of dereliction. It also disregards the devastating impact the proposed changes will have on veterans’ ability to receive care, and inaccurately implies to improve it. As the Senate considers his bill, they should take heed of these and other facts involving this often-misunderstood form of labor.

COVID-19 irrevocably transformed the use of virtual care within the VA and across the world. Even as the pandemic subsides, public and private healthcare systems have continued to utilize telework-centered telehealth far above pre-pandemic levels, especially for mental health and primary care. Employers, including the VA, capitalize on telework for its benefits to both consumers and the workforce. For consumers, research supports the clinical effectiveness of telemental health services, as well as its cost-effectiveness and consumer satisfaction. On the workforce side, research has documented heightened productivity, lower distractibility, and higher job satisfaction among counselors who shifted to remote work.

Remote work also serves as a key tool in attracting and retaining a qualified workforce. As one VA Service Chief explained, “I am having enough trouble competing with the private sector, where extensive telework is now the norm. If telework options were rolled back, the private sector will have a field day picking off my best staff.” These comments are consistent with the data. McKinsey’s American Opportunity Survey shows that Americans have not only embraced remote work, but they want more of it. Recent data from Gallup shows that 6 out of 10 currently exclusively remote employees would be extremely likely to change companies if they lost their remote flexibility. Further, Gallup’s data show that when an employee’s location preference does not match their current work location, burnout rises, and engagement drops.

VA’s expansion of telework between 2019 and 2023 is what has enabled it to meet the growing demand for mental health services. VA is keeping pace by having two or more clinicians rotate between home and a shared VA office. Forcing these hybrid providers to work full-time at VA facilities would drastically reduce the number of patients they are able to care for. There simply aren’t enough offices on crammed VA grounds to house staff who today telework. The net result would be that fewer appointments would be available, creating longer waits. And that’s just for existing patients. It doesn’t factor in the expected influx due to new veteran eligibility made possible by the toxic exposures PACT Act.

Here's another good example of crucial VA telework: With the advent of the “988” suicide prevention lifeline, VA is adding over a thousand new Veterans Crisis Line responders. All these new positions are remote. The SHOW UP Act would inhibit such expansion of lifesaving programs.

Veterans want more, not fewer, telehealth options. At a House Committee on Veterans’ Affairs hearing last September, the VA reported that most veterans would prefer to receive mental health services virtually than to have to commute to a VA medical center or clinic. Telehealth benefits veterans in meaningful ways, including that it reduces their travel time, travel expense, depletion of sick leave and need for childcare. Veterans with PTSD or military sexual trauma who are triggered by traffic and waiting rooms, and those with mobility issues or who struggle with the stigma of mental health treatment prefer the familiarity of their own home for care. Virtual options also relieve a patient’s need to enter a hospital and be unnecessarily exposed to contagious viruses. That’s safer not only for veterans but for VA staff as well.

Finally, virtual care improves treatment. Research has revealed that the likelihood of missing telehealth appointments is lower than for in-person appointments. When patients miss appointments, continuity of care is disrupted, and healthcare outcomes are diminished.

The pandemic is receding, but the advantages of telework-centered virtual care are greater than ever. Political representatives who want to show up for veterans should do everything in their power to expand – not cut – VA’s ability to authorize working from home.

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